Very Low Concentration Levobupivacaine Femoral Nerve Catheter Infusion for Postoperative Pain Management in Total Knee Replacement in Combination with 0.1 mg Spinal Morphine

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Marvin Thepsoparn


Background: Post total knee replacement pain is
categorized as moderate to severe pain. Well management
of postoperative pain will enhance patient recovery. The
study aims to compare between 0.04% levobupivacaine
for femoral nerve catheter in combination with 0.1 milligram
intrathecal morphine with only 0.1% levobupivacaine for
femoral nerve catheter.
Methods: An experimental study, double blinded,
randomized-controlled trial was conducted in total knee
Pateints in LBM group received 0.04% levobupivacaine
combined with 0.1 milligram intrathecal morphine, BM
group received only 0.1% levobupivacaine for femoral
nerve catheter for 48 hours after surgery. Postoperative
pain scores were assessed at 6, 12, 24, 48 hours.
Morphine consumption, nausea-vomiting, itchiness and
muscle weakness of the legs were also assessed.
Results: There were 46 patients included in the study.
Pain scores at rest and while movement at 6 hours were
significant lower in LBM group (3.88 vs 1.61, p=0.005),

(5.88 vs 3.39, p=0.02). However, at 12 hours only
movement pain was lower in LBM group (5.33 vs 4.42,
p=0.034). Muscle weakness of the legs was significant
lower in LBM group (Bromage I 29.4% vs 69.4%,
p=0.028). There was no different on intravenous morphine
consumption, nausea-vomiting and itchiness.
Conclusion: Combined continuous femoral nerve block
catheter with 0.04% levobupivacaine with 0.1 milligram
intrathecal morphine provides effective pain control for
total knee replacement.


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