Comparison of postoperative femoral nerve block, epidural block and intravenous patient-controlled analgesia in pain control and postoperative rehabilitation after total knee arthroplasty

Background: Total knee arthroplasty (TKA) is a commonly used and successful procedure for the treatment of degenerative diseases of the knee joint. However, postoperative pain remains inevitable. We performed this study to compare femoral nerve block (FNB), epidural block and patient-controlled analgesia (PCA) in terms of post-operative pain control and rehabilitation course. Methods: From 2014.1 to 2015.1, we included 82 patients with unilateral TKA in our study. Participants were randomized into three treatment groups: FNB, epidural block and PCA. Postoperative pain was measured with Visual Analogue Scale (VAS) at different time points (0 h, 2 h, 6 h, 12 h, 24 h and 72 h) after surgery. Secondary outcomes include hemodynamic changes, rehabilitation course, complications and side effects. Results: In rest situation, FNB group had the lowest VAS score in the first 6 hours (0 h, 2 h and 6 h) after surgery and the PCA group seemed to suffer most pain in the first 6 hours after surgery. But 24 hours after the surgery, the PCA group had the lowest VAS score. In moving situation, we found that after 24 hours (24 h and 72 h), the PCA group had the lowest VAS score. No difference was found in hemodynamic changes at all time points. The FNB analgesia has the least complications and side effects. Conclusions: FNB and epidural analgesia has a better effect on controlling the acute pain after TKA surgery. The PCA analgesia is more effective in controlling long term pain after the surgery and is more effective in controlling the pain caused by movement. PCA analgesia has a significant advantage in motion rehabilitation and the FNB analgesia suffered least side effects and complications.