Effect of Preemptive Femoral Nerve Block on Pain Control and Opioid Consumption After Total Knee Arthroplasty: A Randomized Controlled Trial


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Caliskan B., Unlusoy E. O., Karaca S.

Haseki Tip Bulteni, cilt.61, sa.5, ss.312-318, 2023 (ESCI, Scopus, TRDizin) identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 61 Sayı: 5
  • Basım Tarihi: 2023
  • Doi Numarası: 10.4274/haseki.galenos.2023.9549
  • Dergi Adı: Haseki Tip Bulteni
  • Derginin Tarandığı İndeksler: Emerging Sources Citation Index (ESCI), Scopus, Academic Search Premier, CINAHL, EMBASE, Directory of Open Access Journals, TR DİZİN (ULAKBİM)
  • Sayfa Sayıları: ss.312-318
  • Anahtar Kelimeler: Femoral nerve block, orthopedic anesthesia, postoperative pain, preemptive, total knee arthroplasty
  • Açık Arşiv Koleksiyonu: AVESİS Açık Erişim Koleksiyonu
  • İstanbul Üniversitesi-Cerrahpaşa Adresli: Hayır

Özet

Aim: Peripheral nerve blocks, particularly femoral nerve blocks (FNBs), are a practical choice for relieving severe pain after total knee arthroplasty (TKA). We investigated the effectiveness of preemptive FNB on postoperative pain control and the reduction of opioid consumption. Methods: This was a single-center, prospective, randomized controlled trial conducted at a tertiary care health center, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Turkey. The study included 40 American Society of Anesthesiologists I-III patients scheduled for elective TKA surgery. Patients were studied in two groups. The FNB group (n=20) received preemptive single-injection FNB (15 mL of prilocaine 2% and 15 mL of 0.5% bupivacaine using a peripheral nerve stimulator) before general anesthesia (GA) as the study group and the control group (n=20) received standardized GA. The primary outcome measure was pain scores evaluated as numeric pain rating scale (0-10) at 2, 4, 8, 12, 16, 18, 20, and 24 h. Secondary outcome measures included opioid consumption with patient-controlled and perioperative hemodynamic changes. Results: Pain scores and opioid consumption in the FNB group were significantly lower than those in the control group at every measurement time (p<0.05). Total perioperative morphine use was also lower in the FNB group (p=0.023). Regarding hemodynamic variables, the heart rate values at the beginning of surgery and tourniquet insufflation in the FNB group were significantly lower than those in the control group. Conclusion: Using the FNB as part of any multimodal analgesia protocol to alleviate pain after TKA with less analgesic use would be beneficial.