Indian Journal of Anaesthesia  
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CLINICAL INVESTIGATION
Year : 2012  |  Volume : 56  |  Issue : 3  |  Page : 270-275

Comparative study of ultrasound-guided continuous femoral nerve blockade with continuous epidural analgesia for pain relief following total knee replacement


1 Department of Anesthesiology and Pain Medicine, McMaster University, Health Sciences Centre 2U1, Hamilton, Ontario, Canada
2 Department of Anaesthesia, Critical Care and Pain, Columbia Asia Referral Hospital, Bangalore, Karnataka, India

Correspondence Address:
Harsha Shanthanna
St Joseph's Healthcare's Charlton Campus, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6
Canada
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5049.98776

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Background: Regional analgesia is widely used for total knee replacement surgeries (TKR) as it has lesser side-effects and better analgesic efficacy when compared with traditional oral analgesics. Peripheral nerve blockade has also been utilized, including continuous infusion techniques. With the use of ultrasound, the needle and catheter placement can be done accurately under real-time guidance. This may prove a more suitable approach compared with the epidural technique. Aims: Post-operative analgesia in TKR patients was compared between continuous epidural analgesia (CEA) and continuous femoral block (CFB) techniques. VAS scores and use of rescue analgesic were used as parameters. Secondary aims included comparison of rehabilitation scores and side-effects in the form hypotension, vomiting, itching and urinary retention. Settings and Design: Randomised, controlled, non-blinded study done in a tertiary care private hospital. Methods: Forty-two patients fulfilling the study criteria were randomised into the CEA and CFB groups. In total, four patients: three in the CFB group and one in the CEA group, were excluded because of catheter migration. Statistical Analysis: Mean VAS score at 6, 6-24, 24-48 and 48-72 h were considered. Significance was assessed at the 5% level. Results and Conclusion: VAS scores were significantly high (P=0.001) in the femoral group at 6 h, after which there was a declining trend, and scores were essentially similar from 24 h. Common side-effects were more common in the CEA group. Our study shows that CFB gives equivalent analgesia compared with CEA in TKR patients with clinically meaningful decrease in side-effects.


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