title: Comparative study of ultrasound-guided continuous femoral nerve blockade with continuous epidural analgesia for pain relief following total knee replacement.
abstract: BACKGROUND
  Regional analgesia is widely used for total knee replacement surgeries (TKR) as it has lesser side-effects and better analgesic efficacy when compared with traditional oral analgesics. Peripheral nerve blockade has also been utilized, including continuous infusion techniques. With the use of ultrasound, the needle and catheter placement can be done accurately under real-time guidance. This may prove a more suitable approach compared with the epidural technique.
  
  
  OBJECTIVE
  Post-operative analgesia in TKR patients was compared between continuous epidural analgesia (CEA) and continuous femoral block (CFB) techniques. VAS scores and use of rescue analgesic were used as parameters. Secondary aims included comparison of rehabilitation scores and side-effects in the form hypotension, vomiting, itching and urinary retention.
  
  
  METHODS
  Randomised, controlled, non-blinded study done in a tertiary care private hospital.
  
  
  METHODS
  Forty-two patients fulfilling the study criteria were randomised into the CEA and CFB groups. In total, four patients: three in the CFB group and one in the CEA group, were excluded because of catheter migration.
  
  
  METHODS
  Mean VAS score at 6, 6-24, 24-48 and 48-72 h were considered. Significance was assessed at the 5% level.
  
  
  CONCLUSIONS
  VAS scores were significantly high (P=0.001) in the femoral group at 6 h, after which there was a declining trend, and scores were essentially similar from 24 h. Common side-effects were more common in the CEA group. Our study shows that CFB gives equivalent analgesia compared with CEA in TKR patients with clinically meaningful decrease in side-effects.
authors.affiliation: Department of Anesthesiology and Pain Medicine, McMaster University, Health Sciences Centre 2U1, Hamilton, Ontario, Canada.
authors.forename: Harsha
authors.initials: H
authors.lastname: Shanthanna
authors.forename: Medha
authors.initials: M
authors.lastname: Huilgol
authors.forename: Vinay Kumar
authors.initials: VK
authors.lastname: Manivackam
authors.forename: Amjad
authors.initials: A
authors.lastname: Maniar