Continuous femoral nerve block after total knee arthroplasty?
BACKGROUND
A continuous femoral nerve block is frequently used as an adjunct therapy after total knee arthroplasty (TKA). However, there is still debate on its benefits.


METHODS
In this prospective, randomized study, patients received a basic analgesic regimen of paracetamol and dicloflenac for the first 48 h postoperatively. In addition, the study group received a continuous femoral nerve block. A morphine patient-controlled analgesia pump was also available as a rescue analgesic to all the patients. Patients' numeric rating scores for pain, the amount of morphine consumed and its side effects during the first 48 h were recorded. Knee flexion angles achieved during the first week were registered. Three months postoperatively, patients completed Western Ontario and McMaster Universities Osteoarthritis Index and Knee Society Score.


RESULTS
The study group (n=27) had less pain (P=0.0016) during the first 48 h, was more satisfied with the analgesia (P<0.001) and used less morphine (P=0.007) compared with the control group (n=26). Fewer patients were nauseated, vomited or were drowsy in the study group (P=0.001). Also, the study group achieved better knee flexion in the first 6 days after surgery (P=0.001), with more patients reaching 90 degrees flexion than the control group. However, after 3 months, there were no significant functional differences between the groups.


CONCLUSIONS
A continuous femoral nerve block leads to better analgesia, less morphine consumption and less morphine-related side effects after TKA. Early functional recovery is improved, resulting in more patients reaching 90 degrees knee flexion after 6 days. However, after 3 months, no significant functional benefits were found.
Kadic
L
L
Department of Anesthesiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. l.kadic@anes.umcn.nl
Boonstra
M C
MC
DE Waal Malefijt
M C
MC
Lako
S J
SJ
VAN Egmond
J
J
Driessen
J J
JJ
D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000775:Anesthesia, Spinal; D019645:Arthroplasty, Replacement, Knee; D004311:Double-Blind Method; D005260:Female; D005267:Femoral Nerve; D006801:Humans; D007717:Knee / Q000033:anatomy & histology / Q000502:physiology; D008297:Male; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D009407:Nerve Block; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D009020:Morphine