A comparison of continuous femoral nerve block (CFNB) and continuous epidural infusion (CEI) in postoperative analgesia and knee rehabilitation after total knee arthroplasty (TKA).
BACKGROUND
Postoperative epidural analgesia (EA) and femoral nerve block (FNB) provided effective pain relief However, EA has common side effects such as nausea, vomiting, pruritus, dizziness, and hypotension. Some investigations found that those side effects were less in FNB than in EA. However the analgesic equivalent of both techniques have not been confirmed.


OBJECTIVE
The authors compared continuous epidural infusion (CEI) with continuous femoral nerve block (CFNB) regarding the postoperative analgesic efficacy, side effects, postoperative knee rehabilitation, and hospital length of stay (LOS).


METHODS
In this prospective, randomized controlled study, 61 ASA physical status I-III patients scheduled for elective unilateral total knee arthroplasty (TKA) under spinal anesthesia (SA) participated. The patients were allocated into two groups. In the ward, patients in Group I (CEI) were maintained by continuous infusion of 0.125% levobupivacaine with morphine 0.0125 mg/ml (4 ml/hr), Group II (CFNB) were maintained by 0.125% levobupivacaine (8 ml/hr).


RESULTS
Patients in the CFNB group, the VAS scores at PO6-12 hr and tramadol IV requirement were significantly greater than the CEI group (VAS: PO6 hr p-value = 0.001, PO12 hr p-value = 0.004). Patients in the CEI group experienced dizziness, pruritus, and PONV more than the CFNB group significantly. Patient satisfaction was greater with the CFNB group although postoperative knee rehabilitation and the hospital LOS were not different.


CONCLUSIONS
CFNB represents the optimal analgesia with fewer side effects and greater patient, satisfaction. The rehabilitation indices and duration of hospital stay are comparable in both groups.
Sundarathiti
Petchara
P
Department of Anesthesiology, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand.
Ruananukul
Narut
N
Channum
Thanapot
T
Kitkunasathean
Chusak
C
Mantay
Aunthika
A
Thammasakulsiri
Jadesadha
J
Sodsee
Wanida
W
D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural / Q000009:adverse effects* / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation*; D002045:Bupivacaine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D005269:Femur / Q000294:innervation*; D006801:Humans; D007278:Injections, Spinal; D007719:Knee Joint / Q000601:surgery*; D007902:Length of Stay; D000077554:Levobupivacaine; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000628:therapy*; D017060:Patient Satisfaction; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced / Q000188:drug therapy; D011446:Prospective Studies; D016896:Treatment Outcome
D000779:Anesthetics, Local; D000077554:Levobupivacaine; D002045:Bupivacaine