Korean J Anesthesiol.  2016 Dec;69(6):587-591. 10.4097/kjae.2016.69.6.587.

In-plane three-step needle insertion technique for ultrasound-guided continuous femoral nerve block after total knee arthroplasty: a retrospective review of 488 cases

• Shin HJ
• Soh JS
• Lim HH
• Joo B
• Lee HW
• Lim HJ

• KMID: 2360473
• DOI: http://doi.org/10.4097/kjae.2016.69.6.587

Abstract

BACKGROUND
Continuous femoral nerve block (CFNB) improves postoperative analgesia after total knee arthroplasty (TKA). The aim of this study was to investigate the clinical efficacy and complications of our in-plane three-step needle insertion technique that was devised to reduce the risk of direct femoral nerve injury during CFNB in anesthetized patients.
METHODS
This retrospective study included 488 patients who had undergone TKA. Ultrasound (US)-guided CFNB was performed under general or spinal anesthesia using an in-plane, three-step needle insertion technique. The success rate and difficulties of catheter placement, clinical efficacy of analgesia, and complications were recorded.
RESULTS
Femoral catheters were placed with a 100% success rate. In 488 patients, real-time US imaging revealed easy separation of the fascia iliaca and the femoral nerve following injection of local anesthetic through a Tuohy needle. Verbal numerical rating scale pain scores (0-10) were 2.0 ± 1.2, 3.5 ± 1.9, 3.2 ± 1.7, 2.9 ± 1.3, and 2.5 ± 1.1 at 1, 6, 12, 24 and 48 h postoperatively. No femoral hematoma, femoral abscess, or neurologic complications, including paresthesia or neurologic deficits, were observed during the 8-week follow-up period.
CONCLUSIONS
This retrospective study suggests that an in-plane three-step needle insertion technique for CFNB may reduce the risk of femoral nerve injury in anesthetized patients.

Keyword

Arthroplasty; Catheters; Femoral nerve; Knee; Ultrasonography

MeSH Terms

Abscess
Analgesia
Anesthesia, Spinal
Arthroplasty
Arthroplasty, Replacement, Knee*
Catheters
Fascia
Femoral Nerve*
Follow-Up Studies
Hematoma
Humans
Knee
Needles*
Neurologic Manifestations
Paresthesia
Retrospective Studies*
Treatment Outcome
Ultrasonography