Medical & Clinical Reviews

Post-operative Peripheral Nerve Blockade for Total Knee Replacement

Background: Total knee replacement (TKR) is a common and often painful operation. Femoral nerve block (FNB) is frequently used for postoperative analgesia. Prospective randomized case study done on 20 patients.

Objectives: The aim of the study is to assess efficacy of peripheral nerve blockade for reliving postoperative pain after total knee replacement. It also assesses patient comfort, pain scoring post-operative 4 days in ward.

Indication: POST-OP analgesia after TKR.

Preparation: Procedure explained in clinic to pt. and family/pre-operative/in recovery Rm/monitors on/O2/IV/P+D/Sterile gown/US/N stimulator/Pt Supine/ Sedation midazolam 1 mg+fentanyl 50 mcg/procedure explained to Pt/Tough 22G insulated 10 cm+catheter.

Findings: Normal Sono anatomy, stimulation of Quads at 0.36 MA.

Management: No pain/blood or Resistance on initial aspiration--->1 ml injection with 5% Dextrose, good facial opening -->Ropivacaine 0.25% given incremental 5 ml to a total of 20 ml+10 ml Dextrose--total 30 ml then Patient tolerated procedure well+ stable vitals.

Results: Patient will be pushed to OR for GA will review patient in post op recovery then patients followed up in ward post-operative foir 4 days-10 patients went smooth recovery with mild pain, VAS 2-5/10, needed small amounts of morphine iv with oral analgesics, on the other hand 20 patients had severe pain and needed morphine iv boluses for 3 days with oral analgesics.

Conclusion: Femoral nerve blockade (with or without concurrent treatments including PCA opioid) provided more effective analgesia than PCA opioid alone and less nausea/vomiting compared with PCA alone or epidural analgesia. Femoral nerve blockade (FNB) before knee replacement surgery can provide superior pain relief and fewer side effects, compared to traditional patientcontrolled opioid analgesia. Further research is needed to compare the effectiveness of FNB to other pain management strategies, such as local anesthetic infiltration and multimodal oral pain medication.

Author(s):

Ali Saad

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