The Effects of Femoral Nerve Blockade in Conjunction with Epidural Analgesia After Total Knee Arthroplasty
ABSTRACT Either epidural analgesia or femoral nerve blockade improves analgesia and rehabilitation after total knee arthroplasty. No study has evaluated the combination of femoral nerve blockade and epidural analgesia. In this prospective, randomized, blinded study we investigated combining femoral nerve blockade with epidural analgesia. Forty-one patients received a single-injection femoral nerve block with 0.375% bupivacaine and 5 microg/mL epinephrine; 39 patients served as controls. All patients received combined spinal-epidural anesthesia and patient-controlled epidural analgesia with 0.06% bupivacaine and 10 microg/mL hydromorphone. Average duration of epidural analgesia was 2 days. All patients received the same standardized physical therapy intervention. Median visual analog scale (VAS) scores with physical therapy were significantly lower for 2 days among patients who received a femoral nerve block versus controls: 3 versus 4 (day 1), 2.5 versus 4 (day 2); P < 0.05. Median VAS pain scores at rest were 0 in both groups on days 1 and 2. Flexion range of motion was improved on postoperative day 2 (70 degrees versus 63 degrees ; P < 0.05). No peripheral neuropathies occurred. We conclude that the addition of femoral nerve blockade to epidural analgesia significantly improved analgesia for the first 2 days after total knee arthroplasty.
- SourceAvailable from: Justin Sangwook Ko
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- "In addition to anesthesia, postoperative pain management can be preemptively performed via PCEA well before the patient feels pain after the surgery.11,12 Numerous studies using epidural analgesia have demonstrated effective analgesia both at rest and upon movement as a single mode of pain management regimen;12,13 however, in our institution, we have frequently noticed inadequate pain relief with PCEA alone, especially on POD 1 when the pain has the highest intensity, and breakthrough rescue analgesic agents, usually intravenous opioids, were often required in order to alleviate intolerable pain. In this regard, it is unclear whether epidural analgesia alone is sufficient to provide complete pain control on POD 1. "
ABSTRACT: 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. 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. 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. The combination of femoral nerve block with epidural analgesia is an effective pain management regimen in patients undergoing unilateral total knee replacement.Yonsei medical journal 01/2011; 52(1):145-50. DOI:10.3349/ymj.2011.52.1.145 · 1.29 Impact Factor
Conference Paper: A comparison of spectral estimators for real data[Show abstract] [Hide abstract]
ABSTRACT: Spectral estimation of real data can be performed by a number of algorithms. This paper compares four methods of estimation. The comparisons are based on three examples which are evaluated in terms of the quality of the estimate, the complexity of the algorithm, and the noise immunity of the estimate. The four estimators are the well-known periodogram, Burg's maximum entropy (AR modelling) method, and two autoregressive-moving average (ARMA) models that have been developed recently here at the University of Colorado [1,2]. The examples chosen contain a smooth spectrum, a spectrum with "high peaks" and "deep valleys", and two sinusoids in white noise. Our results indicate that the ARMA methods are superior in a majority of cases.Acoustics, Speech, and Signal Processing, IEEE International Conference on ICASSP '81.; 05/1981
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ABSTRACT: To investigate the efficacy of single injection femoral nerve block (FNB) on the independence level in functional activities in the early postoperative period in patients with total knee arthroplasty (TKA). We conducted this prospective, randomized, blinded trial in the Department of Orthopedics and Traumatology, Hacettepe University Hospital Ankara, Turkey, between June 2003 and April 2004. Twenty-three patients scheduled for elective TKA were randomly divided into 3 groups. Group I received preemptive single injection FNB, group II received postoperative single injection FNB, and group III served as a control group. Intravenous morphine patient controlled analgesia (PCA) was used following surgery in all groups. Morphine dose and pain score defined by the visual analog scale (VAS) were recorded postoperatively at the 15th minute, 30th minute, 1st, 4th, 6th, 12th, 24th, and 48th hours. A standard rehabilitation protocol was applied for all patients. The independence level in functional activities was assessed during the first 2 postoperative days and at discharge with the Iowa Level of Assistance Scale (ILAS) and the Iowa Ambulation Speed Scale (IASS). Physical therapists that enrolled in the study were blinded to the groups. Pain scores were significantly different between the groups (p<0.05). The preemptive and postoperative FNB group`s VAS scores were both significantly lower than the control group (p<0.05). However, there was no significant difference in VAS scores between preemptive and postoperative FNB groups (p>0.05). There was no statistically significant difference between the groups in any of the functional scores in the first 2 postoperative days, and at discharge (p>0.05). Single injection FNB provided effective analgesia in patients undergoing TKA. However, the independence level in functional activities in the early postoperative period was not influenced by the analgesia method.Neurosciences 07/2006; 11(3):175-9. · 0.71 Impact Factor