title: Complications of femoral nerve block for total knee arthroplasty.
abstract: 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.
authors.affiliation: Department of Orthopaedic Surgery, Lahey Clinic Medical Center, 41 Mall Road, Burlington, MA 01805, USA.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Sharma
authors.forename: Richard
authors.initials: R
authors.lastname: Iorio
authors.forename: Lawrence M
authors.initials: LM
authors.lastname: Specht
authors.forename: Sara
authors.initials: S
authors.lastname: Davies-Lepie
authors.forename: William L
authors.initials: WL
authors.lastname: Healy
mesh_terms: 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
references.citation: Acta Orthop. 2007 Apr;78(2):172-9
references.pmid: 17464603
references.citation: Anesth Analg. 1998 Jul;87(1):88-92
references.pmid: 9661552
references.citation: Anesth Analg. 2008 Apr;106(4):1316-21, table of contents
references.pmid: 18349212
references.citation: JAMA. 1998 Mar 18;279(11):847-52
references.pmid: 9515999
references.citation: J Arthroplasty. 2001 Jun;16(4):436-45
references.pmid: 11402405
references.citation: Anesthesiology. 2002 Nov;97(5):1274-80
references.pmid: 12411815
references.citation: Anesth Analg. 2005 Sep;101(3):891-895
references.pmid: 16116010
references.citation: Anesth Analg. 1999 Nov;89(5):1197-202
references.pmid: 10553834
references.citation: Anesth Analg. 1987 May;66(5):401-6
references.pmid: 3555163
references.citation: Am J Orthop (Belle Mead NJ). 2007 Oct;36(10):554-7
references.pmid: 18033568
references.citation: Br J Anaesth. 2008 Feb;100(2):154-64
references.pmid: 18211990
references.citation: Anesth Analg. 2007 Apr;104(4):996-7; author reply 997-8
references.pmid: 17377128
references.citation: Anesth Analg. 2005 May;100(5):1547-1548
references.pmid: 15845741
references.citation: Reg Anesth. 1996 Jul-Aug;21(4):292-7
references.pmid: 8837185
references.citation: Anesth Analg. 1998 Jul;87(1):93-7
references.pmid: 9661553
references.citation: J Med Assoc Thai. 2006 Apr;89(4):462-7
references.pmid: 16696391
references.citation: Reg Anesth Pain Med. 2002 Mar-Apr;27(2):139-44
references.pmid: 11915059
references.citation: J Arthroplasty. 2007 Sep;22(6 Suppl 2):33-8
references.pmid: 17823012
references.citation: Anaesth Intensive Care. 2006 Oct;34(5):684-5
references.pmid: 17061652
references.citation: Acta Anaesthesiol Sin. 2000 Sep;38(3):143-8
references.pmid: 11125689
references.citation: Clin Orthop Relat Res. 1989 Feb;(239):191-5
references.pmid: 2912621
references.citation: Anesth Analg. 2004 Sep;99(3):954
references.pmid: 15333447
references.citation: J Arthroplasty. 2004 Sep;19(6):720-5
references.pmid: 15343531