Implementation of a Multimodal Analgesic Strategy Including Continuous Femoral Nerve Block in Patients Undergoing Total Knee Arthroplasty
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Jun 25, 2019
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Abstract
Total knee replacement is a painful surgical procedure. The inadequate control of postoperative pain is associated with adverse outcomes in the short and long term. Continuous femoral block has been shown to be effective and efficient as part of multimodal analgesia. This series of 48 patients who underwent total knee replacement, who received multimodal analgesic treatment including continuous femoral nerve block, documents the pain control profile during the first 48 hours. This is a successful experience of implementing regional techniques as part of perioperative pain relief, as documented in the literature. We emphasize that each institution must know its technical and human resource and characterize its patients, in order to implement multimodal analgesia protocols that include this regional technique. We also suggest to monitor and implement continuous improvement processes.
Keywords
Knee arthroplasty, Analgesia, PostoperativeReemplazo total de rodilla. Analgesia, Posoperatorio
References
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2. Grosu I, Lavand'homme P, Thienpont E. Pain after knee arthroplasty: an unresolved issue knee surgery. Knee Surg Sports Traumatol Arthrosc. 2014;22(8):1744-58. https://doi.org/10.1007/s00167-013-2750-2.
3. Chelly JE, Greger J, Gebhard R, Coupe K, Clyburn TA, Buckle R, et al. Continuous femoral blocks improve recovery and outcome of patients undergoing total knee arthroplasty. J Arthroplast 2001;16(4):436-45.
4. 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 [internet]. 1999;(91):8-15. Disponible en: https://pdfs.semanticscholar.org/31d4/e3d1eda3b999431cf4558453ee8459c3571e.pdf
5. Parvizi J, Miller AG, Gandhi K. Multimodal pain management after total joint arthroplasty. J Bone Joint Surg Am. 2011;93(11):1075-84. https://doi.org/10.2106/JBJS.J.01095
6. Horlocker TT. Pain management in total joint arthroplasty: a historical review. Orthopedics. 2010;33(9 Suppl):14-9.
7. Singelyn FJ, Deyaert M, Joris D, Pendeville E, Gouverneur JM. 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;87(1):88-92.
8. Ganapathy S, Wasserman RA, Watson JT, Bennett J, Armstrong KP, Stockall CA, et al. Modified continuous femoral three-in-one block for postoperative pain after total knee arthroplasty. Anesth Analg 1999;89(5):1197-202.
9. Seet E, Leong WL, Yeo AS, Fook-Chong S. Effectiveness of 3-in-1 continuous femoral block of differing concentrations compared to patient controlled intravenous morphine for post total knee arthroplasty analgesia and knee rehabilitation. Anaesth Intensive Care. 2006;34(1):25-30.
10. Chan EY, Fransen M, Sathappan S, Chua NH, Chan YH, Chua N. Comparing the analgesia effects of single-injection and continuous femoral nerve blocks with patient controlled analgesia after total knee arthroplasty. J Arthroplasty. 2013;28(4):608-13.
11. Ey C, Fransen M, Parker DA, Assam PN, Chua N. Femoral nerve blocks for acute postoperative pain after knee replacement surgery. Cochrane Database Syst Rev. 2014;(5):CD009941. https://doi.org/10.1002/14651858.CD009941.pub2.
12. Paul JE, Arya A, Hurlburt L, Cheng J, Thabane L, Tidy A, et al. Femoral nerve block improves analgesia outcomes after ttal kee arthroplasty. Anesthesiology. 2010;103(5):1144-62.
13. Terkawi YS, Mavridis D, Sessler DI, Nunemaker MS, Doais KS, Terkawi RS, et al. Pain management modalities after total knee arthroplasty: a network meta-analysis of 170 randomized controlled trials. Anesthesiology. 2017;126(5):923-37. https://doi.org/10.1097/ALN.0000000000001607.
14. Ilfeld BM, Madison SJ. The sciatic nerve and knee arthroplasty to block, or not to block V that is the question. Anethes Pain Med. 2011;36(5):421-3.
15. Hussain N, et al. Adductor canal block versus femoral nerve block for total knee arthroplasty. Anesthesiology. 2014;120(3):540-50.
16. Elkassabany NM, Antosh S, Ahmed M, Nelson C, Israelite C, Badiola I, et al. The risk of falls after total knee arthroplasty with the use of a femoral nerve block versus an adductor canal block: a double-blinded randomized controlled study. Anesth Analg. 2016;122(5):1696-703. https://doi.org/10.1213/ANE.0000000000001237.
2. Grosu I, Lavand'homme P, Thienpont E. Pain after knee arthroplasty: an unresolved issue knee surgery. Knee Surg Sports Traumatol Arthrosc. 2014;22(8):1744-58. https://doi.org/10.1007/s00167-013-2750-2.
3. Chelly JE, Greger J, Gebhard R, Coupe K, Clyburn TA, Buckle R, et al. Continuous femoral blocks improve recovery and outcome of patients undergoing total knee arthroplasty. J Arthroplast 2001;16(4):436-45.
4. 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 [internet]. 1999;(91):8-15. Disponible en: https://pdfs.semanticscholar.org/31d4/e3d1eda3b999431cf4558453ee8459c3571e.pdf
5. Parvizi J, Miller AG, Gandhi K. Multimodal pain management after total joint arthroplasty. J Bone Joint Surg Am. 2011;93(11):1075-84. https://doi.org/10.2106/JBJS.J.01095
6. Horlocker TT. Pain management in total joint arthroplasty: a historical review. Orthopedics. 2010;33(9 Suppl):14-9.
7. Singelyn FJ, Deyaert M, Joris D, Pendeville E, Gouverneur JM. 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;87(1):88-92.
8. Ganapathy S, Wasserman RA, Watson JT, Bennett J, Armstrong KP, Stockall CA, et al. Modified continuous femoral three-in-one block for postoperative pain after total knee arthroplasty. Anesth Analg 1999;89(5):1197-202.
9. Seet E, Leong WL, Yeo AS, Fook-Chong S. Effectiveness of 3-in-1 continuous femoral block of differing concentrations compared to patient controlled intravenous morphine for post total knee arthroplasty analgesia and knee rehabilitation. Anaesth Intensive Care. 2006;34(1):25-30.
10. Chan EY, Fransen M, Sathappan S, Chua NH, Chan YH, Chua N. Comparing the analgesia effects of single-injection and continuous femoral nerve blocks with patient controlled analgesia after total knee arthroplasty. J Arthroplasty. 2013;28(4):608-13.
11. Ey C, Fransen M, Parker DA, Assam PN, Chua N. Femoral nerve blocks for acute postoperative pain after knee replacement surgery. Cochrane Database Syst Rev. 2014;(5):CD009941. https://doi.org/10.1002/14651858.CD009941.pub2.
12. Paul JE, Arya A, Hurlburt L, Cheng J, Thabane L, Tidy A, et al. Femoral nerve block improves analgesia outcomes after ttal kee arthroplasty. Anesthesiology. 2010;103(5):1144-62.
13. Terkawi YS, Mavridis D, Sessler DI, Nunemaker MS, Doais KS, Terkawi RS, et al. Pain management modalities after total knee arthroplasty: a network meta-analysis of 170 randomized controlled trials. Anesthesiology. 2017;126(5):923-37. https://doi.org/10.1097/ALN.0000000000001607.
14. Ilfeld BM, Madison SJ. The sciatic nerve and knee arthroplasty to block, or not to block V that is the question. Anethes Pain Med. 2011;36(5):421-3.
15. Hussain N, et al. Adductor canal block versus femoral nerve block for total knee arthroplasty. Anesthesiology. 2014;120(3):540-50.
16. Elkassabany NM, Antosh S, Ahmed M, Nelson C, Israelite C, Badiola I, et al. The risk of falls after total knee arthroplasty with the use of a femoral nerve block versus an adductor canal block: a double-blinded randomized controlled study. Anesth Analg. 2016;122(5):1696-703. https://doi.org/10.1213/ANE.0000000000001237.
How to Cite
Grueso Angulo, R., Bonilla Ramírez, A. J., Moreno Oliveros, G. M., Moreno Martínez, D. A., Quesada Montealegre, D. A., Abril, L., Mondragon, M. C., & Matamoros, A. M. (2019). Implementation of a Multimodal Analgesic Strategy Including Continuous Femoral Nerve Block in Patients Undergoing Total Knee Arthroplasty. Universitas Medica, 60(3), 1–7. https://doi.org/10.11144/Javeriana.umed60-3.mult
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