Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2013.07.007
Brazilian Journal of Anesthesiology
Scientific Article

Ultrasound and nerve stimulator guided continuous femoral nerve block analgesia after total knee arthroplasty: a multicenter randomized controlled study

Bloqueio contínuo do nervo femoral guiado por ultrassom e estimulador de nervo para analgesia após artroplastia total de joelho: estudo multicêntrico, randomizado e controlado

Fen Wang; Li-Wei Liu; Zhen Hu; Yong Peng; Xiao-Qing Zhang; Quan Li

Downloads: 0
Views: 634

Abstract

BACKGROUND AND OBJECTIVES: Postoperative analgesia is crucial for early functional excise after total knee arthroplasty. To investigate the clinical efficacy of ultrasound and nerve stimulator guided continuous femoral nerve block analgesia after total knee arthroplasty. METHODS: 46 patients with ASA grade I-III who underwent total knee arthroplasty received postoperative analgesia from October 2012 to January 2013. In 22 patients, ultrasound and nerve stimulator guided continuous femoral nerve block were performed for analgesia (CFNB group); in 24 patients, epidural analgesia was done (PCEA group). The analgesic effects, side effects, articular recovery and complications were compared between two groups. RESULTS: At 6 h and 12 h after surgery, the knee pain score (VAS score) during functional tests after active exercise and after passive excise in CFNB were significantly reduced when compared with PCEA group. The amount of parecoxib used in CFNB patients was significantly reduced when compared with PCEA group. At 48 h after surgery, the muscle strength grade in CFNB group was significantly higher, and the time to ambulatory activity was shorter than those in PCEA group. The incidence of nausea and vomiting in CFNB patients was significantly reduced when compared with PCEA group. CONCLUSION: Ultrasound and nerve stimulator guided continuous femoral nerve block provide better analgesia at 6 h and 12 h, demonstrated by RVAS and PVAS. The amount of parecoxib also reduces, the incidence of nausea and vomiting decreased, the influence on muscle strength is compromised and patients can perform ambulatory activity under this condition.

Keywords

Arthroplasty, Replacement, Knee, Ultrasound, Nerve stimulator, Continuous femoral nerve block

Resumo

JUSTIFICATIVA E OBJETIVOS: Analgesia pós-operatória é fundamental para o exercício funcional precoce logo após a artroplastia total de joelho. O objetivo foi investigar a eficácia clínica do bloqueio contínuo do nervo femoral guiado por ultrassom e estimulador de nervo em analgesia após artroplastia total do joelho. MÉTODOS: Receberam analgesia pós-operatória, de outubro de 2012 a janeiro de 2013, 46 pacientes, estado físico ASA I-III, submetidos à artroplastia total de joelho. Em 22 pacientes, o bloqueio femoral contínuo foi guiado por ultrassom e estimulador de nervo para analgesia (grupo BFC); em 24 pacientes, analgesia foi administrada por via epidural (grupo ACP). Os efeitos analgésicos, efeitos colaterais, a recuperação articular e as complicações foram comparados entre os dois grupos. RESULTADOS: Às seis e 12 horas após a cirurgia, os escores de dor no joelho (escore EVA) durante os testes funcionais após exercício ativo e passivo foram significativamente menores no grupo BFC do que no grupo ACP. A quantidade usada de parecoxib nos pacientes do grupo BFC foi significativamente menor em comparação com o grupo ACP. Quarenta e oito horas após a cirurgia, o grau de força muscular no grupo BFC foi significativamente maior e o tempo de atividade ambulatória foi menor do que no grupo ACP. A incidência de náusea e vômito em pacientes do grupo BFC foi significativamente menor em comparação com o grupo ACP. CONCLUSÃO: O bloqueio femoral contínuo guiado por ultrassom e estimulador do nervo proporcionou melhor analgesia às seis e 12 horas, demonstrada por EVA-R e EVA-P. A quantidade de parecoxib também foi menor, a incidência de náusea e vômito diminuiu, a influência sobre a força muscular é comprometida e os pacientes podem fazer atividade ambulatorial sob essa condição.

Palavras-chave

Artroplastia, Substituição, Joelho, Ultrassom, Estimulador de nervo, Bloqueio femoral contínuo

References

Hu Y, Geng LC. Efficacy of intravenous analgesia and epidural analgesia after knee arthroplasty: a comparative study. China Pract Med.. ;6:98-97.

Qian WW, Weng XS, Fei Q. Application study of periarticular multimodal drug injection in total knee arthroplasty. Natl Med J China.. ;90:2596-2593.

Li L, Luo M, Feng J. Effect of continuous femoral nerve block and epidural analgesia on rehabilitation after total knee arthroplasty surgery. Orthop J China.. ;17:1139-1141.

Fanelli G, Casati A, Garancini P. Nerve stimulator and multiple injection technique for upper and lower limb blockade: failure rate, patient acceptance, and neurologic complications. Study Group on Regional Anesthesia. Anesth Analg.. ;88:847-852.

Franco CD, Vieira ZE. 1001 subclavian perivascular brachial plexus blocks: success with a nerve stimulator. Reg Anesth Pain Med.. ;25:46-41.

Albrecht E, Niederhauser J, Gronchi F. Transient femoral neuropathy after knee ligament reconstruction and nerve stimulator-guided continuous femoral nerve block: a case series. Anaesthesia.. ;66:850-851.

Marhofer P, Greher P, Kapral S. Ultrasound guidance in regional anaesthesia. Br J Anaesth.. ;94:17-7.

Ponde V, Desai AP, Shah D. Comparison of success rate of ultrasound-guided sciatic and femoral nerve block and neurostimulation in children with arthrogryposis multiplex congenita: a randomized clinical trial. Paediatr Anaesth.. ;23:74-78.

Abrahams MS, Aziz MF, Fu RF. Ultrasound guidance compared with electrical neurostimulation for peripheral nerve block: a systematic review and meta-analysis of randomized controlled trials. Br J Anaesth.. ;102:417-408.

Marhofer P, Schrögendorfer K, Koinig H. Ultrasonographic guidance improves sensory block and onset time of three-in-one blocks. Anesth Analg.. ;85:854-857.

Marhofer P, Schrögendorfer K, Wallner T. Ultrasonographic guidance reduces the amount of local anesthetic for 3-in-1 blocks. Reg Anesth Pain Med.. ;23:584-588.

Liu SS, Ngeow JE, Yadeau JT. Ultrasound-guided regional anesthesia and analgesia: a qualitative systematic review. Reg Anesth Pain Med.. ;34:47-59.

Liu SS, Zayas VM, Gordon MA. A prospective, randomized, controlled trial comparing ultrasound versus nerve stimulator guidance for inter scalene block for ambulatory shoulder surgery for postoperative neurological symptoms. Anesth Analg.. ;109:271-265.

Maheshwari AV, Blum YC, Shekhar L. Multimodal pain management after total hip and knee arthroplasty at the Ranawat Orthopaedic Center. Clin Orthop Relat Res.. ;467:1418-1423.

Roehrig S, Straub A, Pohlmann J. Discovery of the novel anti-thrombotic agent 5-chloro-N-({(5S)-2-oxo-3-[4-(3oxomorpholin-4-yl)phenyl]-1,3-oxazolidin-5-yl}methyl) thiophene-2-carboxamide (BAY 59-7939): an oral, direct factor Xa inhibitor. J Med Chem.. ;48:5900-5908.

Lassen MR, Ageno W, Borris LC. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty. N Engl J Med.. ;358:2786-2776.

Turpie AG, Lassen MR, Davidson BL. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty (RECORD4): a randomised trial. Lancet.. ;373:1680-1673.

de la Fuente Tornero E, Garutti Martínez I, Gutiérrez Tonal B. Comparison of hemostatic markers under different techniques for anesthesia-analgesia in total hip or knee replacement. Rev Esp Anestesiol Reanim.. ;6:340-333.

Winnie AP, Ramamuahy S, Dunaai Z. The inguinal para-vascular technic of lumbar plexus anesthesia: the ''3-in-1block''. Anesth Analg.. ;52:996-989.

He DD, Jia DL, Guo XY. Analgesic effects of ultrasonography combined with nerve stimulation guidance for continuous femoral nerve block after total knee arthroplasty. Chin J Mini Invas Surg.. ;11:304-307.

Ye WQ, Yu XR, Gu GS. Femoral nerve block for relieving pain after total knee arthroplasty. Nurs Foreign Med Sci.. ;23:516.

Zhuang XL, Zeng YM, Chen BL. Modern anesthesiology. .

Scott DA, Chamley DM, Mooney PH. Epidural ropivacaine infusion for postoperative analgesia after major lower abdominal surgery a dose finding study. Anesth Analg.. ;81:982-986.

Fowler SJ, Symons J, Sabato S. Epidural analgesia compared with peripheral nerve blockade after major knee surgery: a systematic review and meta-analysis of randomized trials. Br J Anaesth.. ;100:164-154.

Szczukowski MJ, Hines JA, Snell JA. Femoral nerve block for total knee arthroplasty patients: a method to control postoperative pain. J Arthroplasty.. ;19:725-720.

Shanthanna H, Huilgol M, Manivackam VK. Comparative study of ultrasound-guided continuous femoral nerve blockade with continuous epidural analgesia for pain relief following total knee replacement. Indian J Anaesth.. ;56:270-275.

Orebaugh SL, Kentor ML, Williams BA. Adverse outcomes associated with nerve stimulator-guided and ultrasound-guided peripheral nerve blocks by supervised trainees: update of a single-site database. Reg Anesth Pain Med.. ;37:582-577.

Denny NM, Harrop-Griffiths W. Location, location, location! Ultrasound imaging in regional anaesthesia. Br J Anaesth.. ;94:1-3.

Reiss W, Kurapati S, Shariat A. Nerve injury complicating ultrasound/electro-stimulation guided supra clavicular brachial plexus block. Reg Anesth Pain Med.. ;35:401-400.

5dd461310e8825ec66f1efd9 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections