Continuous femoral nerve block after total knee arthroplasty?

被引:39
作者
Kadic, L. [1 ]
Boonstra, M. C. [2 ]
Malefijt, M. C. De Waal [3 ]
Lako, S. J. [1 ]
van Egmond, J. [1 ]
Driessen, J. J. [1 ]
机构
[1] Radboud Univ Nijmegen, Med Ctr, Dept Anesthesiol, NL-6525 GA Nijmegen, Netherlands
[2] Radboud Univ Nijmegen, Med Ctr, Orthopaed Res lab, NL-6525 GA Nijmegen, Netherlands
[3] Radboud Univ Nijmegen, Med Ctr, Dept Orthopaed, NL-6525 GA Nijmegen, Netherlands
关键词
PATIENT-CONTROLLED ANALGESIA; LENGTH-OF-STAY; POSTOPERATIVE ANALGESIA; FUNCTIONAL RECOVERY; REPLACEMENT; MORPHINE; PAIN; REHABILITATION;
D O I
10.1111/j.1399-6576.2009.01965.x
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Background A continuous femoral nerve block is frequently used as an adjunct therapy after total knee arthroplasty (TKA). However, there is still debate on its benefits. Methods In this prospective, randomized study, patients received a basic analgesic regimen of paracetamol and dicloflenac for the first 48 h postoperatively. In addition, the study group received a continuous femoral nerve block. A morphine patient-controlled analgesia pump was also available as a rescue analgesic to all the patients. Patients' numeric rating scores for pain, the amount of morphine consumed and its side effects during the first 48 h were recorded. Knee flexion angles achieved during the first week were registered. Three months postoperatively, patients completed Western Ontario and McMaster Universities Osteoarthritis Index and Knee Society Score. Results The study group (n=27) had less pain (P=0.0016) during the first 48 h, was more satisfied with the analgesia (P < 0.001) and used less morphine (P=0.007) compared with the control group (n=26). Fewer patients were nauseated, vomited or were drowsy in the study group (P=0.001). Also, the study group achieved better knee flexion in the first 6 days after surgery (P=0.001), with more patients reaching 90 degrees flexion than the control group. However, after 3 months, there were no significant functional differences between the groups. Conclusion A continuous femoral nerve block leads to better analgesia, less morphine consumption and less morphine-related side effects after TKA. Early functional recovery is improved, resulting in more patients reaching 90 degrees knee flexion after 6 days. However, after 3 months, no significant functional benefits were found.
引用
收藏
页码:914 / 920
页数:7
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