Comparing epidural analgesia with continuous femoral block using method of parallel patientcontrolled analgesia after total knee arthroplasty


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Abstract

Does continuous femoral block have any advantages over epidural analgesia using patient controlled analgesia (PCA)? This question is still opened. The authors conducted a randomized placebo-controlled trial in order to compare epidural analgesia and continuous femoral block using method of double parallel patient-controlled analgesia after total knee arthroplasty. The results demonstrated that the using of PCA does not increase the consumption of local anesthetic and the number of adverse effects in comparison with epidural analgesia.

About the authors

A. G Voloshin

SBEI “Sechenov First Moscow State Medical University”, 119991, Moscow

D. N Kiryushin

SBEI “Sechenov First Moscow State Medical University”, 119991, Moscow

I. G Mukutsa

SBEI “Sechenov First Moscow State Medical University”, 119991, Moscow

A. B Serebryakov

FSBI “Center of Therapy and rehabilitation”, 125367, Moscow

References

  1. Adams H.A., Saatweber P., Schmitz C.S., Hecker H. Postoperative pain management in orthopaedic patients: no differences in pain score, but improved stress control by epidural anaesthesia. Eur J Anaesthesiol. 2002 Sep; 19 (9): 658-665.
  2. Kehlet H. Surgical stress: the role of pain and analgesia. Br J Anaesth. 1989 Aug; 63 (2): 189-195.
  3. Schug S.A. The effect of neuraxial blockade on peri-operative mortality and major morbidity: an updated meta-analysis. Anaesth Intensive Care. 2005; 33: 675.
  4. Moen V., Dahlgren N., Irestedt L. Severe neurological complications after central neuraxial blockade in Sweden 1990-1999. Anesthesiology. 2004; 101: 950-959.
  5. Chelly J.E., Greger J., Gebhard R. et al. Continuous femoral blocks improve recovery and outcome of patients undergoing total knee arthroplasty. J Arthroplasty. 2001; 16: 436-445.
  6. Horlocker T.T., Kopp S.L., Pagnano M.W., Hebl J.R. Analgesia for total hip and knee arthroplasty: a multimodal pathway featuring peripheral nerve block. J. Am. Acad. Orthop. Surg. 2006; 14: 126-135.
  7. Enneking F.K., Chan V., Greger J., Hadzic A., Lang S.A., Horlocker T.T. Lower-extremity peripheral nerve blockade: essentials of our current understanding. Reg. Anesth. Pain. Med. 2005; 30: 4-35.
  8. Evans H., Steele S.M., Nielsen K.C., Tucker M.S., Klein S.M. Peripheral nerve blocks and continuous catheter techniques. Anesthesiol. Clin. Nort.h America. 2005; 23: 141-162.
  9. Barrington M.J., Olive D., Low K., Scott D.A., Brittain J., Choong P. Continuous femoral nerve blockade or epidural analgesia after total knee replacement: a prospective randomized controlled trial. Anesth Analg. 2005; 101: 1824-1829.
  10. Singelyn F.J., Deyaert M., Joris D., Pendeville E., Gouverneur J.M. Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous three-in-one block on postoperative pain and knee rehabilitation after unilateral total knee arthroplasty. Anesth Analg. 1998 Jul; 87 (1): 88-92.
  11. Capdevila X., Barthelet Y., Biboulet P., Ryckwaert Y., Rubenovitch J., d’Athis F. Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery. Anesthesiology. 1999 Jul; 91 (1): 8-15.
  12. Weber A., Fournier R., Van Gessel E., Gamulin Z. Sciatic nerve block and the improvement of femoral nerve block analgesia after total knee replacement. Eur. J. Anaesthesiol. 2002 Nov; 19 (11): 834-836.
  13. Tarkkila P., Tuominen M., Huhtala J., Lindgren L. Comparison of intrathecal morphine and continuous femoral 3-in-1 block for pain after major knee surgery under spinal anaesthesia. Eur J Anaesthesiol. 1998; 15: 6-9.
  14. Mansour N.Y., Bennetts F.E. An observational study of combined continuous lumbar plexus and single-shot sciatic nerve blocks for post-knee surgery analgesia. Reg Anesth. 1996; 21: 287-291.
  15. Levesque S., Delbos A. Sciatic nerve block for total-knee replacement: Is it really necessary in all patients? Reg. Anesth. Pain Med. 2005; 30: 410-411.
  16. Fowler S.J., Symons J., Sabato S., Myles P.S. Epidural analgesia compared with peripheral nerve blockade after major knee surgery: A systematic review and meta-analysis of randomized trials. Br. J. Anaesth. 2008; 100: 154-164.
  17. Moen V., Dahlgren N., Irestedt L. Severe neurological complications after central neuraxial blockade in Sweden 1990-1999. Anesthesiology. 2004; 101: 950-959.
  18. Schug S.A. Peripheral nerve blockade carries only a minimal risk of permanent neurological complications. Anaesth Intensive Care. 2007; 35: 11-12.
  19. Fischer H.B. Regional anaesthesia before or after general anaesthesia. Anaesthesia. 1998; 53: 727-729.

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