Complications of femoral nerve block for total knee arthroplasty.
Preemptive and multimodal pain control protocols have been introduced to enhance rehabilitation after total knee arthroplasty (TKA). We determined the complication rate associated with preoperative femoral nerve block (FNB) for TKA. Among 1018 TKA operations, we performed 709 FNBs using a single-injection technique into the femoral nerve sheath and confirming position with nerve stimulation before induction. After TKA, weightbearing as tolerated was initiated using a walker or crutches on postoperative Day 1. Twelve patients (1.6%) treated with FNB sustained falls, three (0.4%) of whom underwent reoperations. Five patients had postoperative femoral neuritis, which may have been secondary to the block. One patient had new onset of atrial fibrillation after FNB, and the TKA was postponed. Femoral nerve block before TKA is not a harmless intervention. We recommend postoperative protocols be modified for patients who have FNB to account for decreased quadriceps function in the early postoperative period, which can lead to falls.


METHODS
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Sharma
Sanjeev
S
Department of Orthopaedic Surgery, Lahey Clinic Medical Center, 41 Mall Road, Burlington, MA 01805, USA.
Iorio
Richard
R
Specht
Lawrence M
LM
Davies-Lepie
Sara
S
Healy
William L
WL
D000058:Accidental Falls / Q000706:statistics & numerical data; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000379:methods / Q000534:rehabilitation; D005260:Female; D005267:Femoral Nerve / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D007592:Joint Diseases / Q000188:drug therapy / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects* / Q000379:methods; D009443:Neuritis / Q000139:chemically induced / Q000175:diagnosis / Q000503:physiopathology; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000209:etiology*; D052097:Quadriceps Muscle / Q000187:drug effects / Q000503:physiopathology; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D016474:Weight-Bearing
Acta Orthop. 2007 Apr;78(2):172-9
17464603
Anesth Analg. 1998 Jul;87(1):88-92
9661552
Anesth Analg. 2008 Apr;106(4):1316-21, table of contents
18349212
JAMA. 1998 Mar 18;279(11):847-52
9515999
J Arthroplasty. 2001 Jun;16(4):436-45
11402405
Anesthesiology. 2002 Nov;97(5):1274-80
12411815
Anesth Analg. 2005 Sep;101(3):891-895
16116010
Anesth Analg. 1999 Nov;89(5):1197-202
10553834
Anesth Analg. 1987 May;66(5):401-6
3555163
Am J Orthop (Belle Mead NJ). 2007 Oct;36(10):554-7
18033568
Br J Anaesth. 2008 Feb;100(2):154-64
18211990
Anesth Analg. 2007 Apr;104(4):996-7; author reply 997-8
17377128
Anesth Analg. 2005 May;100(5):1547-1548
15845741
Reg Anesth. 1996 Jul-Aug;21(4):292-7
8837185
Anesth Analg. 1998 Jul;87(1):93-7
9661553
J Med Assoc Thai. 2006 Apr;89(4):462-7
16696391
Reg Anesth Pain Med. 2002 Mar-Apr;27(2):139-44
11915059
J Arthroplasty. 2007 Sep;22(6 Suppl 2):33-8
17823012
Anaesth Intensive Care. 2006 Oct;34(5):684-5
17061652
Acta Anaesthesiol Sin. 2000 Sep;38(3):143-8
11125689
Clin Orthop Relat Res. 1989 Feb;(239):191-5
2912621
Anesth Analg. 2004 Sep;99(3):954
15333447
J Arthroplasty. 2004 Sep;19(6):720-5
15343531