title: Continuous spinal anesthesia versus continuous femoral nerve block for elective total knee replacement.
abstract: BACKGROUND
  Continuous spinal analgesia (CSA) and continuous femoral nerve blockade (CFNB) are well-established procedures for postoperative pain relief. This study compares the efficacy, adverse effects and complications associated with these two analgesic methods in patients undergoing total knee arthroplasty (TKA).
  
  
  METHODS
  Data were analyzed from consecutive patients undergoing TKA under either CSA or spinal anesthesia plus CFNB. Quality of analgesia was assessed based on opioid consumption and pain intensity (visual analogue scale [VAS] where 0=no pain and 10=utmost imaginable pain) until postoperative day 4. In addition, joint mobility was assessed, and any adverse reactions or side effects were noted.
  
  
  RESULTS
  Sixty-two patients had satisfactory postoperative pain relief, and maximum pain scores were reported between 12 and 24 hrs. Median pain scores in the CSA group were significantly lower than those in the CFNB group (1.0 [0.9-1.9] vs. 2.0 [1.5-3.6] for resting pain and 2.0 [1.7-3.1] vs. 5.0 [3.0-5.5] for dynamic pain, respectively; P<0.001 for days 0 and 1; P<0.05 for all other days). Piritramide consumption was significantly higher in the CFNB group (P<0.01). There were no significant differences between the groups for postoperative mobility of the joint or patient satisfaction.
  
  
  CONCLUSIONS
  Both methods demonstrated analgesic efficacy after total knee arthroplasty, although there was less pain severity and opioid consumption use reported with continuous spinal analgesia. However, the use of continuous spinal analgesia is limited by concerns about the risk profile and absence of approved devices for continuous intrathecal infusion.
authors.affiliation: Department of Anesthesiology and Intensive Care, St. Franziskus Hospital Münster, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Krämer
authors.forename: M
authors.initials: M
authors.lastname: Wenk
authors.forename: G
authors.initials: G
authors.lastname: Fischer
authors.forename: M
authors.initials: M
authors.lastname: Möllmann
authors.forename: D M
authors.initials: DM
authors.lastname: Pöpping
mesh_terms: D000368:Aged; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D005267:Femoral Nerve; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009068:Movement; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000188:drug therapy*; D017060:Patient Satisfaction; D010892:Pirinitramide / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D000701:Analgesics, Opioid; D010892:Pirinitramide