A Randomised Controlled Trial of Local Infiltration Analgesia Versus Femoral Nerve Block for Postoperative Analgesia Following Total Knee Arthroplasty.
femoral nerve
local anaesthetic
total knee arthroplasty
Journal
Cureus
ISSN: 2168-8184
Titre abrégé: Cureus
Pays: United States
ID NLM: 101596737
Informations de publication
Date de publication:
02 Sep 2020
02 Sep 2020
Historique:
entrez:
12
10
2020
pubmed:
13
10
2020
medline:
13
10
2020
Statut:
epublish
Résumé
Background Total knee replacement is often associated with significant postoperative pain. Although the use of a femoral nerve block is well-established, local infiltration analgesia has gained popularity in recent years. We compared single-shot local infiltration analgesia with a single-shot femoral nerve block for patients undergoing primary total knee arthroplasty. Methods A total of 194 patients were randomised to receive either local infiltration analgesia (150 ml bupivacaine 0.067% with adrenaline) or a femoral nerve block (20 ml 0.375% levobupivacaine). Both groups received spinal anaesthesia. The primary outcome measure was the total morphine consumption. Secondary outcome measures included: post-operative pain scores, rehabilitation goals, readiness for discharge, and physical, mental, and functional outcomes, including the Oxford Knee Score (OKS). Results A total of 69 patients in the local infiltration analgesia group and 79 patients in the femoral nerve block group were analysed. Median total morphine consumption was significantly greater in the local infiltration analgesia group as compared to the femoral nerve block group (54.67 mg vs 45 mg, respectively, p=0.0388). The post-operative OKS at six weeks was slightly more improved for the femoral nerve block group than for local infiltration analgesia (12.5 vs 9 point median improvements for the femoral nerve block and local infiltration analgesia groups, respectively, p=0.0261). There were no statistically significant differences in other secondary outcome measures. Conclusion A single-shot femoral nerve block significantly reduces the opioid requirement for primary total knee arthroplasty but is otherwise comparable to single-shot local infiltration analgesia.
Identifiants
pubmed: 33042654
doi: 10.7759/cureus.10192
pmc: PMC7534509
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e10192Informations de copyright
Copyright © 2020, Ng et al.
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Clinics (Sao Paulo). 2015 Sep;70(9):648-53
pubmed: 26375568
Br J Anaesth. 2010 Aug;105(2):185-95
pubmed: 20551021
Knee. 2014 Aug;21(4):848-52
pubmed: 24827696
Knee. 2013 Oct;20(5):324-7
pubmed: 23665124
Br J Anaesth. 2016 May;116(5):597-609
pubmed: 27106963
Sci Rep. 2017 Jan 12;7:40721
pubmed: 28079176
J Arthroplasty. 2016 Jun;31(6):1361-1365
pubmed: 26810604
Anaesthesia. 2008 Oct;63(10):1105-23
pubmed: 18627367
Orthop Traumatol Surg Res. 2015 Sep;101(5):565-9
pubmed: 25987449
Iran Red Crescent Med J. 2014 Jan;16(1):e13247
pubmed: 24719708
Acta Orthop. 2011 Aug;82(4):441-7
pubmed: 21561303
J Clin Epidemiol. 2015 Jan;68(1):73-9
pubmed: 25441700
Acta Anaesthesiol Scand. 2011 Aug;55(7):778-84
pubmed: 21463261
Acta Orthop. 2007 Apr;78(2):172-9
pubmed: 17464603
J Arthroplasty. 2007 Sep;22(6 Suppl 2):33-8
pubmed: 17823012
Br J Anaesth. 2014 Sep;113(3):360-74
pubmed: 24939863