Effectiveness of Pain Relief for Femoral Nerve Block in Multimodal Pain Control Protocols in Total Knee Arthroplasty

Mun Su Jeong; Eun Kyoo Song; Jong Keun Seon; Jae Wook Byun; Kyoung Jai Lee; Young Woo Jung

doi:10.4055/jkoa.2011.46.3.237

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Jeong, Song, Seon, Byun, Lee, and Jung: Effectiveness of Pain Relief for Femoral Nerve Block in Multimodal Pain Control Protocols in Total Knee Arthroplasty

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2011; 46(3): 237-243.

Published online: 30 June 2011

DOI: https://doi.org/10.4055/jkoa.2011.46.3.237

Effectiveness of Pain Relief for Femoral Nerve Block in Multimodal Pain Control Protocols in Total Knee Arthroplasty

Mun Su Jeong, M.D., Eun Kyoo Song, M.D., Ph.D., Jong Keun Seon, M.D., Ph.D., Jae Wook Byun, M.D., Kyoung Jai Lee, M.D., Young Woo Jung, M.D.^*

Center for Joint Disease, Chonnam National University Hwasun Hospital, Jeonnam, Korea.

^*Department of Orthopaedic Surgery, Chonnam National University Hospital, Gwangju, Korea.

Correspondence to: Jong Keun Seon, M.D., Ph.D. Center for Joint Disease, Chonnam National University Hwasun Hospital, 160, Ilsimri, Hwasun-eup, Hwasun-gun, Jeonnam 519-809, Korea. TEL: +82-61-379-7676, FAX: +82-61-379-7681, seonbell@yahoo.co.kr

Received 23 July 2010 Accepted 9 November 2010

(open-access):

"This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited."

Abstract

Purpose

Authors evaluated the effectiveness of pain relief of the femoral nerve block in multimodal pain control protocols for patients with total knee arthroplasty in early postoperative period.

Materials and Methods

Seventy-six patients who underwent TKA under general anesthesia were enrolled in this study. Preemptive analgesic medication, periarticular multimodal drug injection, and IV-PCA were used for pain control in all patients. This single-blind, randomized controlled trial included 43 patients in the nerve block group and 33 patients in the control group. In the former group, the femoral nerve block was done by one author with a nerve stimulator set using 0.5% bupivacaine 20 ml and 1% lidocaine 10 ml. Pain scale was measured at 6, 12, 24, 48, 72 hours and 7 days postoperatively. In addition, amount of IV-PCA consumption, numbers of using acute pain rescuer, range of motion, straight leg raising, first ambulation time, and complications related with drugs were evaluated.

Results

Pain scale and the amount of IV-PCA consumption were significantly lower in nerve block group until 48 hours (p=0.04, 0.03), and the range of motion was better compared to the control group (p≤0.02). The number of pain rescue medicines was significantly low in nerve block group within the first 3 days postoperatively (1.36 vs 2.58). The ability to raise a straightened leg was recovered more rapidly in the control group than in the nerve block group; this difference was statistically significant (12 vs 27.9 hours, p=0.02). There were no differences in first ambulation time and incidence of complications between the 2 groups.

Conclusion

Femoral nerve block in the early period after TKA under multimodal pain control protocols showed significant improvement in pain relief and in range of motion, as well as a significant decrease in the requirement of IV PCA and acute pain rescuers.

Keywords: knee, osteoarthritis, total knee arthroplasty, femoral nerve block, periarticular

Figures and Tables

Figure 1

Photograph illustrating periarticular injection in posterior part of knee joint before implant placement.

Figure 2

Photographs illustrating procedure of a femoral nerve block after sterile preparation (A) and 5 cm, 22 gauge Stimuplex insulated needle (B).

Table 1

Demography according to the Method of Pain Control

^*Data show mean. ^†control group; ^‡femoral nerve block group; ROM, range of motion; Mech. axis, mechanical axis; HSS, Hospital for Special Surgery score; FNB, femoral nerve block; N/A, not applicable.

Table 2

Pain Scale (by White AH)

Table 3

Sequential Comparison of Postoperative Pain Scale

Data show mean±SD; ^*independent-samples t-test, p<0.05; ROM, range of motion.

Table 4

Sequential Comparison of Postoperative Active Range of Motion of the Knee

Data show mean±SD; ^*independent-samples t-test, p<0.05.

Table 5

Comparison of the Amount of Volume Infused by Intravenous Patient Controlled Anesthesia

Data show mean±SD; ^*independent-samples t-test, p<0.05.

Table 6

Comparison of Complications by Injected Drug

^*Pearson's chi-square, p>0.05; Persist Q-m weakness, persist quadriceps muscle weakness.

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