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Single-injection or Continuous Femoral Nerve Block for Total Knee Arthroplasty?
Abstract
Background The ideal local anesthetic regime for femoral nerve block that balances analgesia with mobility after total knee arthroplasty (TKA) remains undefined.
  • References (30)
  • Cited By (19)
Hirst Gc1
Estimated H-index: 1
,
Lang Sa1
Estimated H-index: 1
+ 2 AuthorsYip Rw1
Estimated H-index: 1
87 Citations Source
2008 in AnaesthesiaIF: 5.43
J. J. Paauwe1
Estimated H-index: 1
,
B. J. Thomassen1
Estimated H-index: 1
+ 2 AuthorsM. E. Ausems1
Estimated H-index: 1
Summary Femoral nerve blockade is recommended for analgesia following total knee arthroplasty. Following implementation of this type of postoperative analgesia in our hospital we found that active mobilization the day after surgery, may be difficult due to insufficient quadriceps muscle strength. We therefore designed a pilot study comparing the effect of ropivacaine 0.1%, 0.05% or 0.025% on the patient’s postoperative rehabilitation and analgesia. Three groups of 12 patients received bolus dose...
21 Citations Source Cite
2010 in AnesthesiologyIF: 6.52
James Paul19
Estimated H-index: 19
,
Aman Arya3
Estimated H-index: 3
+ 4 AuthorsYamini Murthy3
Estimated H-index: 3
Background: Femoral nerve blockade (FNB) is a common method of analgesia for postoperative pain control after total knee arthroplasty. We conducted a systematic review to compare the analgesia outcomes in randomized controlled trials that compared FNB (with and without sciatic nerve block) with epidural and patient-controlled analgesia (PCA). Methods: We identified 23 randomized controlled trials that compared FNB with PCA or epidural analgesia. These studies included 1,016 patients, 665 with FN...
238 Citations Source Cite
2006 in Anesthesia & AnalgesiaIF: 3.46
Francis V. Salinas13
Estimated H-index: 13
,
Spencer S. Liu45
Estimated H-index: 45
,
Michael F. Mulroy24
Estimated H-index: 24
Total knee arthroplasty (TKA) may result in severe pain, and single-injection femoral nerve blocks (SFNB) have been demonstrated to have a limited duration of analgesia. Continuous femoral nerve blocks (CFNB) can prolong the analgesic duration of SFNB. We prospectively randomized 36 patients undergoing TKA to CFNB versus SFNB and evaluated the effect on hospital length of stay (LOS) as the primary outcome within a standardized clinical pathway. Secondary outcomes included visual analog scale (VA...
133 Citations Download PDF Cite
James R. Hebl26
Estimated H-index: 26
(Mayo Clinic),
John A. Dilger8
Estimated H-index: 8
(Mayo Clinic)
+ 5 AuthorsTerese T. Horlocker47
Estimated H-index: 47
(Mayo Clinic)
Background and Objectives Patients undergoing major orthopedic surgery experience significant postoperative pain. Failure to provide adequate analgesia may impede early physical therapy and rehabilitation, which are important factors for maintaining joint range of motion and facilitating hospital dismissal. We examined the effect of a pre-emptive, multimodal, perioperative analgesic regimen emphasizing peripheral nerve block in patients undergoing total hip (THA) and total knee (TKA) arthroplast...
142 Citations Source Cite
2010 in PLOS MedicineIF: 11.68
Kenneth F. Schulz78
Estimated H-index: 78
(Research Triangle Park),
Douglas G. Altman200
Estimated H-index: 200
(University of Oxford),
David Moher124
Estimated H-index: 124
(Ottawa Hospital Research Institute)
The CONSORT statement is used worldwide to improve the reporting of randomised controlled trials. Kenneth Schulz and colleagues describe the latest version, CONSORT 2010, which updates the reporting guideline based on new methodological evidence and accumulating experience. To encourage dissemination of the CONSORT 2010 Statement, this article is freely accessible on www.ijph.it.
495 Citations Source Cite
2010 in Anesthesia & AnalgesiaIF: 3.46
Brian M. Ilfeld41
Estimated H-index: 41
,
Kimberly B. Duke2
Estimated H-index: 2
,
Michael Donohue34
Estimated H-index: 34
BACKGROUND: Continuous peripheral nerve blocks (CPNB) may induce muscle weakness, and multiple recently published series emphasize patient falls after postarthroplasty CPNB. However, none have included an adequate control group, and therefore the relationship between CPNB and falls remains speculative. METHODS: We pooled data from 3 previously published, randomized, triple-masked, placebo-controlled studies of CPNB involving the femoral nerve after knee and hip arthroplasty. RESULTS: No patients...
194 Citations Source Cite
2004 in DrugsIF: 4.69
Tracy L. Skaer22
Estimated H-index: 22
(Washington State University)
Patients with moderate-to-severe malignancy-related pain require opioid pharmacotherapy. Many cancer patients continue to be prescribed subtherapeutic doses of pain medications resulting in undue suffering and diminished quality of life. Pain associated with malignancy and its treatment may exacerbate other symptoms associated with cancer, including nausea, fatigue, weakness, dyspnoea, constipation and impaired cognition. The choice of analgesic pharmacotherapy should be individualised and based...
51 Citations Source Cite
2008 in AnesthesiologyIF: 6.52
Brian M. Ilfeld41
Estimated H-index: 41
(University of California, San Diego),
Linda T. Le10
Estimated H-index: 10
(University of Florida)
+ 10 AuthorsDouglas W. Theriaque33
Estimated H-index: 33
(University of Florida)
Background The authors tested the hypotheses that, compared with an overnight continuous femoral nerve block (cFNB), a 4-day ambulatory cFNB increases ambulation distance and decreases the time until three specific readiness-for-discharge criteria are met after tricompartment total knee arthroplasty.
139 Citations Download PDF Cite
  • References (30)
  • Cited By (19)
Kelly Byrne5
Estimated H-index: 5
(Waikato Hospital),
James Clark (Waikato Hospital)
Abstract Despite over one million knee replacements being undertaken worldwide per year, there is still no widely accepted optimal analgesic regime for this procedure. This article examines and appraises the options for total knee arthroplasty in the current environment which mandates rapid discharge from hospital. Peripheral nerve blockade and multimodal analgesic options are covered in detail, along with newer techniques such as high volume local anaesthetic infiltration and infiltration with ...
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2015 in Journal of ArthroplastyIF: 3.34
Jordan L. Ludwigson1
Estimated H-index: 1
(University of Wisconsin-Madison),
Samuel D. Tillmans1
Estimated H-index: 1
(University of Wisconsin-Madison)
+ 3 AuthorsKristopher M. Schroeder7
Estimated H-index: 7
(University of Wisconsin-Madison)
Abstract The aim of this study was to compare perioperative analgesia provided by single-injection adductor canal block (ACB) to continuous femoral nerve catheter (FNC) when used in a multimodal pain protocol for total knee arthroplasty (TKA). A retrospective cohort study compared outcome data for 148 patients receiving a single-injection ACB to 149 patients receiving an FNC. The mean length of stay (LOS) in the ACB group was 2.67 (±0.56) and 3.01 days (±0.57) in the FNC group ( P P P =0.01). Si...
14 Citations Source Cite
Joseph Millum11
Estimated H-index: 11
(National Institutes of Health),
Christine Grady38
Estimated H-index: 38
(National Institutes of Health)
The use of placebo controls in clinical trials remains controversial. Ethical analysis and international ethical guidance permit the use of placebo controls in randomized trials when scientifically indicated in four cases: (1) when there is no proven effective treatment for the condition under study; (2) when withholding treatment poses negligible risks to participants; (3) when there are compelling methodological reasons for using placebo, and withholding treatment does not pose a risk of serio...
19 Citations Source Cite
2015 in Journal of ArthroplastyIF: 3.34
Nilen A. Shah8
Estimated H-index: 8
(Bombay Hospital, Indore),
Nimesh Prakash Jain2
Estimated H-index: 2
(Bombay Hospital, Indore),
Karnav A. Panchal1
Estimated H-index: 1
(Bombay Hospital, Indore)
Abstract Total knee arthroplasty (TKA) can be associated with severe pain in early postoperative period. Adductor canal block may provide optimal analgesia following TKA. However, ideal regimen for administration whether continuous or single shot is yet undefined. We prospectively randomized 90 patients in continuous and single shot adductor canal blockade groups. Postoperative VAS (visual analog scale for pain) score was significantly better at all times in continuous than single shot technique...
21 Citations Source Cite
Andrew P. Sprowson11
Estimated H-index: 11
(University of Warwick),
Iain McNamara2
Estimated H-index: 2
(University of Warwick),
Andrew Manktelow1
Estimated H-index: 1
(University of Warwick)
Abstract The increasing number of joint replacement arthroplasties is an increasing burden on worldwide healthcare resources. Enhanced Recovery Pathway (ERP) is used by most units in the UK and elsewhere aims to improve patient's functional outcome. This article reviews ERP and its components in hip and knee replacement.
1 Citations Source Cite
Kelly Byrne5
Estimated H-index: 5
(Waikato Hospital)
To the editor, I read the study by Albrecht et al. [1] with great interest. The authors should be commended for attempting to answer the complex question of whether there is any benefit of continuous femoral nerve block over a single shot nerve block. Clearly this was one of the major unanswered questions in the meta-analysis from Paul et al. [3]. However, there seem to be several problems with this study. First, their choice of ropivacaine concentrations was odd, given previous work by Brodner ...
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Éric Albrecht8
Estimated H-index: 8
(University of Lausanne),
Dorothea Morfey2
Estimated H-index: 2
(University Hospitals of Leicester NHS Trust),
Richard Brull34
Estimated H-index: 34
(University of Toronto)
To the editor, We would like to thank Dr. Byrne for his comments regarding our recent publication exploring the effects of a single injection versus two types of continuous infusion for femoral nerve block [1]. We agree that Brodner and colleagues [3] previously have concluded that ropivacaine 0.2% and ropivacaine 0.3% were equivalent in terms of pain outcomes compared to ropivacaine 0.1% when used as continuous infusion for femoral nerve blocks. However, Brodner and colleagues designed their st...
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Huichao Fu3
Estimated H-index: 3
(Shanghai Jiao Tong University),
Jiaxing Wang15
Estimated H-index: 15
(Shanghai Jiao Tong University)
+ 2 AuthorsXianlong Zhang23
Estimated H-index: 23
(Shanghai Jiao Tong University)
Purpose Pain management after total knee arthroplasty (TKA) should permit early knee mobilization with minimal pain. Periarticular injection (PAI) with local anaesthetics has been recently discussed as a protocol of pain control. The purpose of this review of the literature was to evaluate the efficacy of PAI in comparison with femoral nerve block (FNB).
5 Citations Source Cite
2015 in Journal of ArthroplastyIF: 3.34
Nilen A. Shah8
Estimated H-index: 8
(Bombay Hospital, Indore),
Nimesh P. Jain1
Estimated H-index: 1
(Bombay Hospital, Indore)
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View next paperPain Management After Total Knee Arthroplasty: A Case-Control Study of Continuous Femoral Nerve Block Therapy