Addition of femoral nerve block to epidural infusion for pain control post total knee arthroplasty

Does it make a difference?

Research output: Contribution to journalArticle

Abstract

Introduction: Effective post-operative analgesia is a major factor in functional outcome after total knee arthroplasty (TKA). To reduce post-operative pain and expedite recovery, peripheral nerve blocks, such as the femoral nerve block (FNB) have been used as an adjunct to the analgesic regime. We assessed whether the addition of a FNB to continuous epidural analgesia (CEA) would improve pain control after TKA. Materials and Methods: A prospective, randomised, controlled study was conducted on 58 patients undergoing TKA and randomised into two groups. The CEA+FNB Group received a single-shot FNB of 30 ml 0.5% bupivacaine using a nerve stimulator technique. The CEA Group acted as a control group and did not receive FNB. Patients in both groups then received combined spinal-epidural anaesthesia for the surgery. Post-operative epidural infusion with 0.1% bupivacaine and 2 μg/ml of fentanyl, at 6 ml/hr was continued up to 48 hours post-operatively. Visual analogue scale (VAS) scores, motor blockade, requirement of rescue analgesia and patient satisfaction were recorded. Results: VAS scores were not significantly different between the CEA+FNB and CEA groups during rest (3 vs. 2) and flexion (5 vs. 6) on postoperative day-1 and during rest (1 vs. 2) and flexion (4 vs. 4) on postoperative day-2. There was no significant difference in rescue analgesia required, the volume of epidural infusion, motor blockade or patient satisfaction between both groups. Conclusion: We concluded that the addition of FNB to epidural infusion did not improve analgesia after TKA.

Original languageEnglish
Pages (from-to)334-341
Number of pages8
JournalBrunei International Medical Journal
Volume8
Issue number6
Publication statusPublished - Dec 2012

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Femoral Nerve
Knee Replacement Arthroplasties
Nerve Block
Epidural Analgesia
Pain
Analgesia
Bupivacaine
Visual Analog Scale
Patient Satisfaction
Epidural Anesthesia
Spinal Anesthesia
Fentanyl
Peripheral Nerves
Analgesics
Control Groups

Keywords

  • Epidural analgesia
  • Femoral nerve block
  • Regional anaesthesia
  • Total knee arthroplasty

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{f1ed5d8266014feca1836ce704b6987b,
title = "Addition of femoral nerve block to epidural infusion for pain control post total knee arthroplasty: Does it make a difference?",
abstract = "Introduction: Effective post-operative analgesia is a major factor in functional outcome after total knee arthroplasty (TKA). To reduce post-operative pain and expedite recovery, peripheral nerve blocks, such as the femoral nerve block (FNB) have been used as an adjunct to the analgesic regime. We assessed whether the addition of a FNB to continuous epidural analgesia (CEA) would improve pain control after TKA. Materials and Methods: A prospective, randomised, controlled study was conducted on 58 patients undergoing TKA and randomised into two groups. The CEA+FNB Group received a single-shot FNB of 30 ml 0.5{\%} bupivacaine using a nerve stimulator technique. The CEA Group acted as a control group and did not receive FNB. Patients in both groups then received combined spinal-epidural anaesthesia for the surgery. Post-operative epidural infusion with 0.1{\%} bupivacaine and 2 μg/ml of fentanyl, at 6 ml/hr was continued up to 48 hours post-operatively. Visual analogue scale (VAS) scores, motor blockade, requirement of rescue analgesia and patient satisfaction were recorded. Results: VAS scores were not significantly different between the CEA+FNB and CEA groups during rest (3 vs. 2) and flexion (5 vs. 6) on postoperative day-1 and during rest (1 vs. 2) and flexion (4 vs. 4) on postoperative day-2. There was no significant difference in rescue analgesia required, the volume of epidural infusion, motor blockade or patient satisfaction between both groups. Conclusion: We concluded that the addition of FNB to epidural infusion did not improve analgesia after TKA.",
keywords = "Epidural analgesia, Femoral nerve block, Regional anaesthesia, Total knee arthroplasty",
author = "Melvin Kandasamy and Muhammad Maaya and {Abdul Rahman}, Raha and {Md Nor}, Nadia and Nurlia Yahya",
year = "2012",
month = "12",
language = "English",
volume = "8",
pages = "334--341",
journal = "Brunei International Medical Journal",
issn = "1560-5876",
publisher = "Ministry of Health and Universiti Brunei Darussalem",
number = "6",

}

TY - JOUR

T1 - Addition of femoral nerve block to epidural infusion for pain control post total knee arthroplasty

T2 - Does it make a difference?

AU - Kandasamy, Melvin

AU - Maaya, Muhammad

AU - Abdul Rahman, Raha

AU - Md Nor, Nadia

AU - Yahya, Nurlia

PY - 2012/12

Y1 - 2012/12

N2 - Introduction: Effective post-operative analgesia is a major factor in functional outcome after total knee arthroplasty (TKA). To reduce post-operative pain and expedite recovery, peripheral nerve blocks, such as the femoral nerve block (FNB) have been used as an adjunct to the analgesic regime. We assessed whether the addition of a FNB to continuous epidural analgesia (CEA) would improve pain control after TKA. Materials and Methods: A prospective, randomised, controlled study was conducted on 58 patients undergoing TKA and randomised into two groups. The CEA+FNB Group received a single-shot FNB of 30 ml 0.5% bupivacaine using a nerve stimulator technique. The CEA Group acted as a control group and did not receive FNB. Patients in both groups then received combined spinal-epidural anaesthesia for the surgery. Post-operative epidural infusion with 0.1% bupivacaine and 2 μg/ml of fentanyl, at 6 ml/hr was continued up to 48 hours post-operatively. Visual analogue scale (VAS) scores, motor blockade, requirement of rescue analgesia and patient satisfaction were recorded. Results: VAS scores were not significantly different between the CEA+FNB and CEA groups during rest (3 vs. 2) and flexion (5 vs. 6) on postoperative day-1 and during rest (1 vs. 2) and flexion (4 vs. 4) on postoperative day-2. There was no significant difference in rescue analgesia required, the volume of epidural infusion, motor blockade or patient satisfaction between both groups. Conclusion: We concluded that the addition of FNB to epidural infusion did not improve analgesia after TKA.

AB - Introduction: Effective post-operative analgesia is a major factor in functional outcome after total knee arthroplasty (TKA). To reduce post-operative pain and expedite recovery, peripheral nerve blocks, such as the femoral nerve block (FNB) have been used as an adjunct to the analgesic regime. We assessed whether the addition of a FNB to continuous epidural analgesia (CEA) would improve pain control after TKA. Materials and Methods: A prospective, randomised, controlled study was conducted on 58 patients undergoing TKA and randomised into two groups. The CEA+FNB Group received a single-shot FNB of 30 ml 0.5% bupivacaine using a nerve stimulator technique. The CEA Group acted as a control group and did not receive FNB. Patients in both groups then received combined spinal-epidural anaesthesia for the surgery. Post-operative epidural infusion with 0.1% bupivacaine and 2 μg/ml of fentanyl, at 6 ml/hr was continued up to 48 hours post-operatively. Visual analogue scale (VAS) scores, motor blockade, requirement of rescue analgesia and patient satisfaction were recorded. Results: VAS scores were not significantly different between the CEA+FNB and CEA groups during rest (3 vs. 2) and flexion (5 vs. 6) on postoperative day-1 and during rest (1 vs. 2) and flexion (4 vs. 4) on postoperative day-2. There was no significant difference in rescue analgesia required, the volume of epidural infusion, motor blockade or patient satisfaction between both groups. Conclusion: We concluded that the addition of FNB to epidural infusion did not improve analgesia after TKA.

KW - Epidural analgesia

KW - Femoral nerve block

KW - Regional anaesthesia

KW - Total knee arthroplasty

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VL - 8

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EP - 341

JO - Brunei International Medical Journal

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