Femoral nerve block improves analgesia outcomes after total knee arthroplasty: a meta-analysis of randomized controlled trials.
BACKGROUND
Femoral nerve blockade (FNB) is a common method of analgesia for postoperative pain control after total knee arthroplasty. We conducted a systematic review to compare the analgesia outcomes in randomized controlled trials that compared FNB (with and without sciatic nerve block) with epidural and patient-controlled analgesia (PCA).


METHODS
We identified 23 randomized controlled trials that compared FNB with PCA or epidural analgesia. These studies included 1,016 patients, 665 with FNB, 161 with epidural, and 190 with PCA alone.


RESULTS
All 10 studies of single-shot FNB (SSFNB) used concurrent PCA opioids. SSFNB was found to reduce PCA morphine consumption at 24 h (-19.9 mg, 95% credible interval [CrI]: -35.2 to -4.6) and 48 h (-38.0 mg, 95% CrI: -56.0 to -19.7), pain scores with activity (but not at rest) at 24 and 48 h (-1.8 visual analog pain scale, 95% CrI: -3.3 to -0.02 at 24 h; -1.5 visual analog pain scale, 95% CrI: -2.9 to -0.02 at 48 h) and reduce the incidence of nausea (0.37 odds ratio, 95% CrI: 0.1 to 0.9) compared with PCA alone. SSFNB had similar morphine consumption and pain scores compared with SSFNB plus sciatic nerve block, and SSFNB plus continuous FNB.


CONCLUSIONS
SSFNB or continuous FNB (plus PCA) was found to be superior to PCA alone for postoperative analgesia for patients having total knee arthroplasty. The impact of adding a sciatic block or continuous FNB to a SSFNB needs to be studied further.
Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada. james_paul@sympatico.ca
James E
JE
Paul
Aman
A
Arya
Lindsay
L
Hurlburt
Ji
J
Cheng
Lehana
L
Thabane
Antonella
A
Tidy
Yamini
Y
Murthy
D000698:Analgesia / Q000379:methods; D016058:Analgesia, Patient-Controlled / Q000379:methods; D019645:Arthroplasty, Replacement, Knee / Q000379:methods; D005267:Femoral Nerve / Q000502:physiology; D006801:Humans; D009407:Nerve Block / Q000379:methods; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D016896:Treatment Outcome