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A Single Injection Ultrasound-Assisted Femoral Nerve Block Provides Side Effect-Sparing Analgesia When Compared with Intrathecal Morphine in Patients Undergoing Total Knee Arthroplasty

Sites, Brian D; Beach, Michael; Gallagher, John D; Jarrett, Robert A; Sparks, Michael B and Lundberg, Johan LU (2004) In Anesthesia and Analgesia 99. p.1539-1543
Abstract
Postoperative pain after total knee arthroplasty (TKA) is severe, and achieving adequate analgesia remains a clinical challenge. We tested the hypothesis that, in patients having unilateral TKA under intrathecal (IT) anesthesia, the addition of a femoral nerve block would provide superior analgesia when compared with IT morphine and demonstrate fewer adverse side effects. In a single-blinded and controlled trial, 41 ASA I–III patients undergoing unilateral TKA were randomized into 2 groups. Both groups received 15 mg of IT hyperbaric bupivacaine for the surgical anesthetic. Group ITM received 250 µg of IT morphine and group FNB received an ultrasound-assisted femoral nerve block with 40 mL of 0.5% ropivacaine, 5 µg/mL of epinephrine, and... (More)
Postoperative pain after total knee arthroplasty (TKA) is severe, and achieving adequate analgesia remains a clinical challenge. We tested the hypothesis that, in patients having unilateral TKA under intrathecal (IT) anesthesia, the addition of a femoral nerve block would provide superior analgesia when compared with IT morphine and demonstrate fewer adverse side effects. In a single-blinded and controlled trial, 41 ASA I–III patients undergoing unilateral TKA were randomized into 2 groups. Both groups received 15 mg of IT hyperbaric bupivacaine for the surgical anesthetic. Group ITM received 250 µg of IT morphine and group FNB received an ultrasound-assisted femoral nerve block with 40 mL of 0.5% ropivacaine, 5 µg/mL of epinephrine, and 75 µg of clonidine. At 1, 2, 4, 6, 12, and 24 h postoperatively, we measured visual analog scales for pain, cumulative IV morphine consumption, hemodynamics, and side effects. There were no statistically significant differences in morphine consumption, pain at rest, or pain with movement. However, group FNB had fewer perioperative side effects including nausea, vomiting, and pruritus (P < 0.05 for each event). This corresponded to a decrease in patient satisfaction in group ITM, in which 20% of the patients rated their experience as "unsatisfactory" (P < 0.05). We conclude that, in comparison with IT morphine, a single injection femoral nerve block provides equivalent analgesia but with a significant reduction in side effects for patients having TKA under bupivacaine intrathecal anesthesia. (Less)
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author
publishing date
type
Contribution to journal
publication status
published
subject
in
Anesthesia and Analgesia
volume
99
pages
1539 - 1543
publisher
Lippincott Williams & Wilkins
external identifiers
  • scopus:6444239380
ISSN
1526-7598
DOI
10.1213/01.ANE.0000136470.51029.52
language
English
LU publication?
no
id
b2aedb7f-c88d-4220-8486-4e10c134408e (old id 1130621)
date added to LUP
2008-06-18 11:45:35
date last changed
2017-11-12 03:56:20
@article{b2aedb7f-c88d-4220-8486-4e10c134408e,
  abstract     = {Postoperative pain after total knee arthroplasty (TKA) is severe, and achieving adequate analgesia remains a clinical challenge. We tested the hypothesis that, in patients having unilateral TKA under intrathecal (IT) anesthesia, the addition of a femoral nerve block would provide superior analgesia when compared with IT morphine and demonstrate fewer adverse side effects. In a single-blinded and controlled trial, 41 ASA I–III patients undergoing unilateral TKA were randomized into 2 groups. Both groups received 15 mg of IT hyperbaric bupivacaine for the surgical anesthetic. Group ITM received 250 µg of IT morphine and group FNB received an ultrasound-assisted femoral nerve block with 40 mL of 0.5% ropivacaine, 5 µg/mL of epinephrine, and 75 µg of clonidine. At 1, 2, 4, 6, 12, and 24 h postoperatively, we measured visual analog scales for pain, cumulative IV morphine consumption, hemodynamics, and side effects. There were no statistically significant differences in morphine consumption, pain at rest, or pain with movement. However, group FNB had fewer perioperative side effects including nausea, vomiting, and pruritus (P &lt; 0.05 for each event). This corresponded to a decrease in patient satisfaction in group ITM, in which 20% of the patients rated their experience as "unsatisfactory" (P &lt; 0.05). We conclude that, in comparison with IT morphine, a single injection femoral nerve block provides equivalent analgesia but with a significant reduction in side effects for patients having TKA under bupivacaine intrathecal anesthesia.},
  author       = {Sites, Brian D and Beach, Michael and Gallagher, John D and Jarrett, Robert A and Sparks, Michael B and Lundberg, Johan},
  issn         = {1526-7598},
  language     = {eng},
  pages        = {1539--1543},
  publisher    = {Lippincott Williams & Wilkins},
  series       = {Anesthesia and Analgesia},
  title        = {A Single Injection Ultrasound-Assisted Femoral Nerve Block Provides Side Effect-Sparing Analgesia When Compared with Intrathecal Morphine in Patients Undergoing Total Knee Arthroplasty},
  url          = {http://dx.doi.org/10.1213/01.ANE.0000136470.51029.52},
  volume       = {99},
  year         = {2004},
}