Analgesia for total hip and knee arthroplasty: A multimodal pathway featuring peripheral nerve block
Patients undergoing total hip and knee arthroplasty experience substantial and sustained postoperative pain. Inadequate analgesia may impede physical therapy and rehabilitative efforts and delay hospital dismissal. Traditionally, postoperative analgesia after total joint replacement was provided by either intravenous patient-controlled analgesia or epidural analgesia. Each, however, had disadvantages as well as advantages. Peripheral nerve blockade of the lumbosacral plexus has emerged as an alternative analgesic approach. In several studies, unilateral peripheral block provided a quality of analgesia and functional outcomes similar to those of continuous epidural analgesia and superior to those of systemic analgesia, but with fewer side effects because of their opioid-sparing properties. Peripheral nerve block techniques may be the optimal analgesic method following total joint arthroplasty.
Available from: PubMed Central
- "The use of CFNB was also associated with less analgesic medications for rescue, indicating the advantage of peripheral nerve block over intravenous patient controlled analgesia in controlling acute perioperative pain and the development of chronic postoperative pain. In this study, we observed less severity of pain and slightly improved degree of flexion on 7 days postoperatively, suggesting a rehabilitation-enhancing effect than continuously intravenous infusion of analgesics, which reinforced the evidence from other randomized controlled trials that femoral nerve block could bring good quality of postoperative analgesia compared to systemic analgesics or epidural analgesia and thus fasten the recovery process and allow patients to be more mobile after total knee arthroplasty [13, 14]. "
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ABSTRACT: Objectives. To evaluate the comparative analgesia effectiveness and safety of postoperative continuous femoral nerve block (CFNB) with patient controlled intravenous analgesia (PCIA) and their impact on knee function and chronic postoperative pain. Methods. Participants were randomly allocated to receive postoperative continuous femoral nerve block (group CFNB) or intravenous patient controlled analgesia (group PCIA). Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores for knee and incidence of chronic postoperative pain at 3, 6, and 12 months postoperatively were compared. postoperative pain and salvage medication at rest or during mobilization 24 hours, 48 hours, and 7 days postoperatively were also recorded. Results. After discharge from the hospital and rehabilitation of joint function, patients in group CFNB reported significantly improved knee flexion and less incidence of chronic postoperative pain at 3 months and 6 months postoperatively (P < 0.05). Analgesic rescue medications were significantly reduced in patients receiving CFNB (P < 0.001 and P = 0.031, resp.). Conclusion. With standardized rehabilitation therapy, continuous femoral nerve block analgesia reduced the incidence of chronic postoperative pain, improved motility of replaced joints, and reduced the dosages of rescue analgesic medications, suggesting a recovery-enhancing effect of peripheral nerve block analgesia.
Available from: Justin Sangwook Ko
- "Alternatively, FNB, both single-injection and continuous modalities, has been shown to provide effective postoperative analgesia.3-6,8,14 The purported advantages of FNB include unilateral analgesia, decreased incidences of opioid-related side-effects and fewer complications compared with epidural analgesia.4,15 Additionally, the key effect of FNBs on postoperative pain may be due to its ability to reduce pain from significant quadriceps spasm occurring from TKR.3,16 "
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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.
Available from: Barbara Lisowska
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ABSTRACT: Summary The article presents anaesthetic problems in patients with rheumatoidarthritis (RA) underwent orthopaedic surgeries. Related treatment of RA was taken into account. Perioperative management, the anaesthetic techniques and the postoperative analgesia used in patients with RA scheduled for orthopaedic procedures and own experi- ences were presented. Anestezjologia i Ratownictwo 2008; 2: 314-319.
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