title: A randomised controlled trial comparing three analgesia regimens following total knee joint replacement: continuous femoral nerve block, intrathecal morphine or both.
abstract: This randomised controlled trial compared three analgesia regimens following primary unilateral total knee joint replacement: continuous femoral nerve block (CFNB), intrathecal morphine (ITM), and both. The primary outcome was pain ratings over the first 24 hours. Secondary outcomes included morphine consumption, nausea, pruritus and sedation ratings, oxygen saturation (SpO2) ratings, and ability to mobilise postoperatively. All patients received a spinal anaesthetic and a postoperative patient-controlled morphine pump. Patients were randomised to receive CFNB, ITM, or both. In patients with no CFNB, the use of ITM was blinded. Eighty-one patients were randomised and there were no withdrawals. At 24 hours, the ITM-only group had higher pain ratings than either of the other groups (P=0.04 versus CFNB, P=0.01 versus combination). In the 18 to 24 hour period, the ITM group used more morphine than either of the other groups. There were no statistically significant differences in pain ratings or morphine consumption at earlier time intervals. The ITM group were less likely to be able to sit out of bed on day one. Patients who received ITM were more likely to have pruritus. There were no statistically significant differences in nausea, SpO₂or sedation ratings. This study showed that a CFNB resulted in reduced pain and was also associated with less morphine consumption and improved mobilisation at 24 hours compared to ITM. This study did not show any statistically significant differences between CFNB alone and CFNB+ITM.
authors.affiliation: Staff Specialist Anaesthetist, Department of Anaesthesia, St Vincent's Hospital, Melbourne, Victoria.
authors.forename: D J
authors.initials: DJ
authors.lastname: Olive
authors.affiliation: Staff Specialist Anaesthetist, Department of Anaesthesia, St Vincent's Hospital, Melbourne, Victoria.
authors.forename: M J
authors.initials: MJ
authors.lastname: Barrington
authors.affiliation: Research Nurse, Department of Anaesthesia, St Vincent's Hospital, Melbourne, Victoria.
authors.forename: S A
authors.initials: SA
authors.lastname: Simone
authors.affiliation: Staff Specialist Anaesthetist, Department of Anaesthesia, St Vincent's Hospital, Melbourne, Victoria.
authors.forename: R
authors.initials: R
authors.lastname: Kluger
mesh_terms: D000368:Aged; D000577:Amides; D000698:Analgesia / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local; D019645:Arthroplasty, Replacement, Knee; D002045:Bupivacaine; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D005267:Femoral Nerve / Q000187:drug effects; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D009020:Morphine / Q000008:administration & dosage*; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy*; D000077212:Ropivacaine; D016896:Treatment Outcome
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D000077212:Ropivacaine; D002045:Bupivacaine
keywords: analgesia; arthroplasty; femoral nerve; knee joint; knee replacement