Femoral nerve block-sciatic nerve block vs. femoral nerve block-local infiltration analgesia for total knee arthroplasty: A randomized controlled trial

Mari Nagafuchi, Tomoyuki Sato, Takahiro Sakuma, Akemi Uematsu, Hiromasa Hayashi, Hidenori Tanikawa, Kazunari Okuma, Akira Hashiuchi, Junya Oshida, Hiroshi Morisaki

Research output: Contribution to journalArticle

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Abstract

Background: The use of femoral nerve block (FNB) combined with sciatic nerve block (SNB) after total knee arthroplasty (TKA) has recently become controversial. Local infiltration analgesia (LIA) has been reported to be effective for postoperative TKA pain control. We aimed to assess whether LIA with continuous FNB is as effective as SNB combined with continuous FNB. Methods: This was a prospective, randomized, single-center, observer-blinded, parallel group comparison trial of 34 American Society of Anesthesiologists (ASA) physical status 1-3 patients who underwent TKA and fulfilled the inclusion and exclusion criteria. Patients were randomized into two groups: a periarticular LIA and FNB group (group L, n = 17), and an SNB and FNB group (group S, n = 17). In both groups, participants received FNB with 20 mL of 0.375 % ropivacaine, and 5 mL h-1 of 0.2 % ropivacaine after surgery. In group L, participants received 100-ml injections of 0.2 % ropivacaine and 0.5 mg epinephrine to the surgical region. In group S, participants received SNB with 20 ml of 0.375 % ropivacaine. After TKA, Numeric Rating Scale (NRS) scores for the first 24 h post-operation were compared via repeated-measures analysis of variance (ANOVA) as the primary outcome. Other outcome measures included NRS score changes within groups, area under the curve for the NRS scores, total analgesic dose, change in knee flexion and extension, pain control satisfaction, nausea and vomiting, and hospital stay duration. Results: NRS score changes were greater in group L than in group S (P <0.01, ANOVA) and greater in group L than in group S at three postoperative time points: 3 h (P <0.01), 6 h (P <0.01), and 12 h (P = 0.013; Mann-Whitney U test). Changes in the mean NRS score were observed in each group (P <0.01, Friedman test). No significant differences were detected in the other outcome measures (Mann-Whitney U, Wilcoxon signed-rank, and chi-squared tests). Conclusions: Sciatic nerve block with femoral nerve block is superior to local anesthetic infiltration with femoral nerve block for postoperative pain control within 3-12 h of total knee arthroplasty. Trial registration:UMIN-CTR ID: 000013364 R: 000015591

Original languageEnglish
Article number182
JournalBMC Anesthesiology
Volume15
Issue number1
DOIs
Publication statusPublished - 2015 Dec 15

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Femoral Nerve
Knee Replacement Arthroplasties
Nerve Block
Sciatic Nerve
Analgesia
Randomized Controlled Trials
Analysis of Variance
Outcome Assessment (Health Care)
Pain
Postoperative Pain
Nonparametric Statistics
Local Anesthetics
Nausea
Epinephrine
Area Under Curve
Vomiting
Analgesics

Keywords

  • Femoral nerve
  • Knee arthroplasty
  • Local anesthesia
  • Nerve block
  • Postoperative pain
  • Sciatic nerve

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Femoral nerve block-sciatic nerve block vs. femoral nerve block-local infiltration analgesia for total knee arthroplasty : A randomized controlled trial. / Nagafuchi, Mari; Sato, Tomoyuki; Sakuma, Takahiro; Uematsu, Akemi; Hayashi, Hiromasa; Tanikawa, Hidenori; Okuma, Kazunari; Hashiuchi, Akira; Oshida, Junya; Morisaki, Hiroshi.

In: BMC Anesthesiology, Vol. 15, No. 1, 182, 15.12.2015.

Research output: Contribution to journalArticle

Nagafuchi, Mari ; Sato, Tomoyuki ; Sakuma, Takahiro ; Uematsu, Akemi ; Hayashi, Hiromasa ; Tanikawa, Hidenori ; Okuma, Kazunari ; Hashiuchi, Akira ; Oshida, Junya ; Morisaki, Hiroshi. / Femoral nerve block-sciatic nerve block vs. femoral nerve block-local infiltration analgesia for total knee arthroplasty : A randomized controlled trial. In: BMC Anesthesiology. 2015 ; Vol. 15, No. 1.
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abstract = "Background: The use of femoral nerve block (FNB) combined with sciatic nerve block (SNB) after total knee arthroplasty (TKA) has recently become controversial. Local infiltration analgesia (LIA) has been reported to be effective for postoperative TKA pain control. We aimed to assess whether LIA with continuous FNB is as effective as SNB combined with continuous FNB. Methods: This was a prospective, randomized, single-center, observer-blinded, parallel group comparison trial of 34 American Society of Anesthesiologists (ASA) physical status 1-3 patients who underwent TKA and fulfilled the inclusion and exclusion criteria. Patients were randomized into two groups: a periarticular LIA and FNB group (group L, n = 17), and an SNB and FNB group (group S, n = 17). In both groups, participants received FNB with 20 mL of 0.375 {\%} ropivacaine, and 5 mL h-1 of 0.2 {\%} ropivacaine after surgery. In group L, participants received 100-ml injections of 0.2 {\%} ropivacaine and 0.5 mg epinephrine to the surgical region. In group S, participants received SNB with 20 ml of 0.375 {\%} ropivacaine. After TKA, Numeric Rating Scale (NRS) scores for the first 24 h post-operation were compared via repeated-measures analysis of variance (ANOVA) as the primary outcome. Other outcome measures included NRS score changes within groups, area under the curve for the NRS scores, total analgesic dose, change in knee flexion and extension, pain control satisfaction, nausea and vomiting, and hospital stay duration. Results: NRS score changes were greater in group L than in group S (P <0.01, ANOVA) and greater in group L than in group S at three postoperative time points: 3 h (P <0.01), 6 h (P <0.01), and 12 h (P = 0.013; Mann-Whitney U test). Changes in the mean NRS score were observed in each group (P <0.01, Friedman test). No significant differences were detected in the other outcome measures (Mann-Whitney U, Wilcoxon signed-rank, and chi-squared tests). Conclusions: Sciatic nerve block with femoral nerve block is superior to local anesthetic infiltration with femoral nerve block for postoperative pain control within 3-12 h of total knee arthroplasty. Trial registration:UMIN-CTR ID: 000013364 R: 000015591",
keywords = "Femoral nerve, Knee arthroplasty, Local anesthesia, Nerve block, Postoperative pain, Sciatic nerve",
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T1 - Femoral nerve block-sciatic nerve block vs. femoral nerve block-local infiltration analgesia for total knee arthroplasty

T2 - A randomized controlled trial

AU - Nagafuchi, Mari

AU - Sato, Tomoyuki

AU - Sakuma, Takahiro

AU - Uematsu, Akemi

AU - Hayashi, Hiromasa

AU - Tanikawa, Hidenori

AU - Okuma, Kazunari

AU - Hashiuchi, Akira

AU - Oshida, Junya

AU - Morisaki, Hiroshi

PY - 2015/12/15

Y1 - 2015/12/15

N2 - Background: The use of femoral nerve block (FNB) combined with sciatic nerve block (SNB) after total knee arthroplasty (TKA) has recently become controversial. Local infiltration analgesia (LIA) has been reported to be effective for postoperative TKA pain control. We aimed to assess whether LIA with continuous FNB is as effective as SNB combined with continuous FNB. Methods: This was a prospective, randomized, single-center, observer-blinded, parallel group comparison trial of 34 American Society of Anesthesiologists (ASA) physical status 1-3 patients who underwent TKA and fulfilled the inclusion and exclusion criteria. Patients were randomized into two groups: a periarticular LIA and FNB group (group L, n = 17), and an SNB and FNB group (group S, n = 17). In both groups, participants received FNB with 20 mL of 0.375 % ropivacaine, and 5 mL h-1 of 0.2 % ropivacaine after surgery. In group L, participants received 100-ml injections of 0.2 % ropivacaine and 0.5 mg epinephrine to the surgical region. In group S, participants received SNB with 20 ml of 0.375 % ropivacaine. After TKA, Numeric Rating Scale (NRS) scores for the first 24 h post-operation were compared via repeated-measures analysis of variance (ANOVA) as the primary outcome. Other outcome measures included NRS score changes within groups, area under the curve for the NRS scores, total analgesic dose, change in knee flexion and extension, pain control satisfaction, nausea and vomiting, and hospital stay duration. Results: NRS score changes were greater in group L than in group S (P <0.01, ANOVA) and greater in group L than in group S at three postoperative time points: 3 h (P <0.01), 6 h (P <0.01), and 12 h (P = 0.013; Mann-Whitney U test). Changes in the mean NRS score were observed in each group (P <0.01, Friedman test). No significant differences were detected in the other outcome measures (Mann-Whitney U, Wilcoxon signed-rank, and chi-squared tests). Conclusions: Sciatic nerve block with femoral nerve block is superior to local anesthetic infiltration with femoral nerve block for postoperative pain control within 3-12 h of total knee arthroplasty. Trial registration:UMIN-CTR ID: 000013364 R: 000015591

AB - Background: The use of femoral nerve block (FNB) combined with sciatic nerve block (SNB) after total knee arthroplasty (TKA) has recently become controversial. Local infiltration analgesia (LIA) has been reported to be effective for postoperative TKA pain control. We aimed to assess whether LIA with continuous FNB is as effective as SNB combined with continuous FNB. Methods: This was a prospective, randomized, single-center, observer-blinded, parallel group comparison trial of 34 American Society of Anesthesiologists (ASA) physical status 1-3 patients who underwent TKA and fulfilled the inclusion and exclusion criteria. Patients were randomized into two groups: a periarticular LIA and FNB group (group L, n = 17), and an SNB and FNB group (group S, n = 17). In both groups, participants received FNB with 20 mL of 0.375 % ropivacaine, and 5 mL h-1 of 0.2 % ropivacaine after surgery. In group L, participants received 100-ml injections of 0.2 % ropivacaine and 0.5 mg epinephrine to the surgical region. In group S, participants received SNB with 20 ml of 0.375 % ropivacaine. After TKA, Numeric Rating Scale (NRS) scores for the first 24 h post-operation were compared via repeated-measures analysis of variance (ANOVA) as the primary outcome. Other outcome measures included NRS score changes within groups, area under the curve for the NRS scores, total analgesic dose, change in knee flexion and extension, pain control satisfaction, nausea and vomiting, and hospital stay duration. Results: NRS score changes were greater in group L than in group S (P <0.01, ANOVA) and greater in group L than in group S at three postoperative time points: 3 h (P <0.01), 6 h (P <0.01), and 12 h (P = 0.013; Mann-Whitney U test). Changes in the mean NRS score were observed in each group (P <0.01, Friedman test). No significant differences were detected in the other outcome measures (Mann-Whitney U, Wilcoxon signed-rank, and chi-squared tests). Conclusions: Sciatic nerve block with femoral nerve block is superior to local anesthetic infiltration with femoral nerve block for postoperative pain control within 3-12 h of total knee arthroplasty. Trial registration:UMIN-CTR ID: 000013364 R: 000015591

KW - Femoral nerve

KW - Knee arthroplasty

KW - Local anesthesia

KW - Nerve block

KW - Postoperative pain

KW - Sciatic nerve

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