Comparison of Single-injection and Continuous Femoral Nerve Block after Primary Total Knee Arthroplasty on Postoperative Pain Control and Length of Hospital Stay: A Randomized, Double-blind Study

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Suwimon Tangwiwat


Introduction: Effective pain management, including the use of peripheral nerve block (PNB) and multimodal analgesia is important to facilitate and enhance recovery after painful total knee arthroplasty (TKA) surgery. Objective: This study aimed to compare the analgesic efficacy between single-injection (sFNB) and continuous femoral nerve block (cFNB) in patient undergoing TKA within 48 hours. Materials and Methods: This prospective, randomized double-blind study was conducted in 56 elective primary TKA. Patients were allocated to receive either sFNB (n=28) or cFNB (n=28). In sFNB received 0.25% levobupivacaine 30 ml for single injection, while cFNB received 0.1% levobupivacaine 30 ml single injection then infusion 0.08% levobupivacaine 4 ml/hr. The primary outcome was morphine consumption within 48 hours after surgery. The secondary outcomes included postoperative numerical pain score (NRS), PNB-related and opioid-related side effects, patient satisfaction and length of stay (LOS). Results: Demographic data was not statistically different between the two groups. Mean difference postoperative morphine consumption was significantly lower in group cFNB compared to sFNB at 24 hours (MD 8.15 mg; 95% CI=0.60-15.70, p<0.05), and 48 hours (MD 10.33 mg; 95% CI=0.35-20.32, p<0.05). There was no statistical difference in the secondary outcomes. Higher rate of quadriceps weakness occurred significantly more in group cFNB than sFNB (48% vs 3.8%; p<0.05) in the physiotherapist’s documentation while the rate of falls was 3.7% in cFNB. Conclusion: CFNB displayed better analgesia properties compared to a single-injection FNB after TKA, however, the perineural technique was associated with higher rate of quadriceps muscle weakness and increased risk of falls


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1. Korean Knee Society. Guidelines for the management of
postoperative pain after total knee arthroplasty. Knee Surg
Relat Res 2012;24:201-7.
2. Karlsen AP, Wetterslev M, Hansen SE, Hansen MS,
Mathiesen O, Dahl JB. Postoperative pain treatment after
total knee arthroplasty: A systematic review. PLoS One 2017;
3. Rutherford RW, Jennings JM, Dennis DA. Enhancing recovery
after total knee arthroplasty. Orthop Clin North Am
4. Iamaroon A SA, Tangwiwat S, Saetang S, Rungwattanakit P,
Thanakiattinwibun C. Moderate -to-severe pain after knee
arthroplasty: a retrospective study of incidence and risk
factors. Thai J Anesthesiol 2020;2:71-9.
5. Paul JE, Arya A, Hurlburt L, et al. Femoral nerve block
improves analgesia outcomes after total knee arthroplasty:
a meta-analysis of randomized controlled trials. Anesthesiology
6. Allen HW, Liu SS, Ware PD, Nairn CS, Owens BD. Peripheral
nerve blocks improve analgesia after total knee replacement
surgery. Anesth Analg 1998;87:93-7.
7. Ma HH, Chou TA, Tsai SW, Chen CF, Wu PK, Chen WM. The
efficacy of continuous versus single-injection femoral nerve
block in total knee arthroplasty: a systematic review and
meta-analysis. BMC Musculoskelet Disord 2020;21:121.
8. Salinas FV, Liu SS, Mulroy MF. The effect of single-injection
femoral nerve block versus continuous femoral nerve block
after total knee arthroplasty on hospital length of stay and
long-term functional recovery within an established clinical
pathway. Anesth Analg 2006;102:1234-9.
9. Szczukowski MJ, Jr., Hines JA, Snell JA, Sisca TS. Femoral
nerve block for total knee arthroplasty patients: a method to
control postoperative pain. J Arthroplasty 2004;19:720-5.
10. Cappiello G, Camarda L, Pulito G, et al. Continuous femoral
catheter for postoperative analgesia after total knee
arthroplasty. Med Arch 2020;74:54-7.
11. Albrecht E, Morfey D, Chan V, et al. Single-injection or
continuous femoral nerve block for total knee arthroplasty?
Clin Orthop Relat Res 2014;472:1384-93.
12. Li S, Zhou J, Li X, et al. Analgesic impact of single-shot
versus continuous femoral nerve block after total knee
arthroplasty: A systematic review and meta-analysis. Adv
Ther 2020;37:671-85.
13. Patel AH, Ross BJ, Ofa SA, Flick TR, Sanchez FL, Sherman
WF. The impact of femoral nerve anesthesia on short-term
clinical outcomes and opioid claims after total knee
arthroplasty. Arthroplast Today 2020;6:1016-21.e9.
14. Gustafson KJ, Pinault GC, Neville JJ,et al. Fascicular anatomy
of human femoral nerve: implications for neural prostheses
using nerve cuff electrodes. J Rehabil Res Dev 2009;46:973-84.
15. Sharma S, Iorio R, Specht LM, Davies-Lepie S, Healy WL.
Complications of femoral nerve block for total knee
arthroplasty. Clin Orthop Relat Res 2010;468:135-40.
16. Ilfeld BM, Duke KB, Donohue MC. The association between
lower extremity continuous peripheral nerve blocks and
patient falls after knee and hip arthroplasty. Anesth Analg
17. Turbitt LR, McHardy PG, Casanova M, Shapiro J, Li L, Choi
S. Analysis of inpatient falls after total knee arthroplasty in
patients with continuous femoral nerve block. Anesth Analg
18. Wasserstein D, Farlinger C, Brull R, Mahomed N, Gandhi R.
Advanced age, obesity and continuous femoral nerve
blockade are independent risk factors for inpatient falls after
primary total knee arthroplasty. J Arthroplasty 2013;28:1121-4.
19. Lin X, Zhou Y, Zheng H, et al. Enhanced preoperative
education about continuous femoral nerve block with
patient-controlled analgesia improves the analgesic effect
for patients undergoing total knee arthroplasty and reduces
the workload for ward nurses. BMC Anesthesiol 2019;19:150.
20. Gadsden JC, Sata S, Bullock WM, Kumar AH, Grant SA,
Dooley JR. The relative analgesic value of a femoral nerve
block versus adductor canal block following total knee
arthroplasty: a randomized, controlled, double-blinded
study. Korean J Anesthesiol 2020;73:417-24.
21. Zhang Z, Wang Y, Liu Y. Effectiveness of continuous adductor
canal block versus continuous femoral nerve block in patients
with total knee arthroplasty: A PRISMA guided systematic
review and meta-analysis. Medicine (Baltimore) 2019;98:
22. Garg J, Kathuria S, Gautam PL, Luthra N, Gupta S. Comparison
of intra-articular analgesia and femoral nerve block for
postoperative pain relief in unilateral total knee arthroplasty:
A randomized clinical study. Anesth Essays Res 2020;14:
23. Paglia A, Goderecci R, Ciprietti N, Lagorio M, Necozione S,
Calvisi V. Pain management after total knee arthroplasty:
A prospective randomized study. J Clin Orthop Trauma
24. Kwofie MK, Shastri UD, Gadsden JC, et al. The effects of
ultrasound-guided adductor canal block versus femoral
nerve block on quadriceps strength and fall risk: a blinded,
randomized trial of volunteers. Reg Anesth Pain Med
25. Muhly WT, Orebaugh SL. Ultrasound evaluation of the
anatomy of the vessels in relation to the femoral nerve at the
femoral crease. Surg Radiol Anat 2011;33:491-4.
26. Marhofer P, Schrögendorfer K, Koinig H, Kapral S,
Weinstabl C, Mayer N. Ultrasonographic guidance improves
sensory block and onset time of three-in-one blocks. Anesth
Analg 1997;85:854-7.