Yonsei Med J.  2011 Jan;52(1):145-150. 10.3349/ymj.2011.52.1.145.

Effect of Combined Single-Injection Femoral Nerve Block and Patient-Controlled Epidural Analgesia in Patients Undergoing Total Knee Replacement

• Lee AR
• Choi DH
• Ko JS
• Choi SJ
• Hahm TS
• Kim GH
• Moon YH

• KMID: 1106449
• DOI: http://doi.org/10.3349/ymj.2011.52.1.145

Abstract

PURPOSE
Total knee replacement is one of the most painful orthopedic procedures, and effective pain relief is essential for early mobility and discharge from hospital. The aim of this study was to evaluate whether addition of single-injection femoral nerve block to epidural analgesia would provide better postoperative pain control, compared to epidural analgesia alone, after total knee replacement.
MATERIALS AND METHODS
Thirty-eight patients received a single-injection femoral nerve block with 0.25% levobupivacaine (30 mL) combined with epidural analgesia (femoral nerve block group) and 40 patients received epidural analgesia alone (control group). Pain intensity and volume of patient-controlled epidural analgesia medication and rescue analgesic requirements were measured in the first 48 hours after surgery at three time periods; 0-6 hours, 6-24 hours, and 24-48 hours. Also, side effects such as nausea, vomiting, and pruritus were evaluated.
RESULTS
Median visual analog scale at rest and movement was significantly lower until 48 hours in the femoral nerve block group. Patient-controlled epidural analgesia volume was significantly lower throughout the study period, however, rescue analgesia requirements were significantly lower only up to 6 hours in the femoral nerve block group. The incidences of nausea and vomiting and rescue antiemetic requirement were significantly lower in the femoral nerve block group up to 6 hours.
CONCLUSION
The combination of femoral nerve block with epidural analgesia is an effective pain management regimen in patients undergoing unilateral total knee replacement.

Keyword

Femoral nerve block; patient-controlled epidural analgesia; total knee replacement; visual analog scale

MeSH Terms

Aged
Analgesia, Epidural/*methods
Analgesia, Patient-Controlled/*methods
Anesthetics, Local/administration & dosage/therapeutic use
Arthroplasty, Replacement, Knee/*methods
Bupivacaine/administration & dosage/analogs & derivatives/therapeutic use
Female
Femoral Nerve/*drug effects
Humans
Injections
Male
Middle Aged
Nerve Block/*methods

Figure

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  Fig. 1 Temporal pain visual analog scale (VAS) at rest and with movement (flexion of knee). The box depicts the 25th and 75th percentiles. Horizontal lines represent the median (50th percentile), and bars depict the 10th and the 90th percentiles. *p < 0.05 compared with the control group.

• 

  Fig. 2 Volume of patient-controlled epidural analgesia medication. Values are expressed as mean ± standard deviation. *p < 0.05 compared with the control group. PCEA, patient-controlled epidural analgesia.

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