Postoperative analgesia for total knee replacement: comparing between pre-and postoperative "3-in-1" femoral nerve block.
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Date
2006-04-16
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Abstract
BACKGROUND: Total Knee Replacement (TKR) produces severe postoperative pain. Pre- and postoperative single-shot "3-in-1" Femoral Nerve Block (FNB) were reported to improve analgesia and reduce morphine consumption post TKR.
OBJECTIVE: To find out the most beneficial time for injection of single shot "3-in-1" FNB for TKR between preoperative and postoperative in a prospective controlled trial.
MATERIAL AND METHOD: In a Randomized, double-blind Controlled Trial (RCT), 48 patients undergoing TKR received either pre- or postoperative "3-in-1" FNB using 30 mL of bupivacaine 0.25% after a standardized general anesthesia. Morphine consumption, Numeric Pain-Rating Scale (NPRS) at rest and during movement, tension in the back of the knee, nausea/vomiting, pruritus, sedation, and respiratory depression at 1, 4, 24 and 48 hr after TKR were compared RESULTS: There were no significant differences in 48-hr morphine consumption [46.5 (20.0) vs 45.0 (23.6) mg, p = 0.809], NPRS both at rest and during movement, tension in the back of knee, nausea/vomiting, pruritus, sedation, and respiratory depression at any time during 48-hr postoperative TKR between groups.
CONCLUSION: Preoperative single-shot "3-in-1" FNB using 30 mL of bupivacaine 0.25% is not better than postoperative single-shot "3-in-1" FNB using the same drug in postoperative pain and morphine reduction in patients undergoing elective TKR under general anesthesia.
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Chotmaihet Thangphaet.
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Bunburaphong P, Niruthisard S, Werawatganon T, Keeyapaj W, Vimuktanandana A, Toleb K. Postoperative analgesia for total knee replacement: comparing between pre-and postoperative "3-in-1" femoral nerve block. Journal of the Medical Association of Thailand. 2006 Apr; 89(4): 462-7