A Prospective, Randomized, Blinded Trial to Compare Continuous Epidural Block and Femoral Nerve Block for Total Knee Arthroplasty
- *Corresponding Author:
- Mitsuharu Kodaka
Department of Anesthesiology
Tokyo Women’s Medical University
School of Medicine, Tokyo 116-8567, Japan
E-mail: [email protected]
Received Date: April 24, 2014; Accepted Date: May 21, 2014; Published Date: June 05, 2014
Citation: Kodaka M, Minayoshi H, Ichikawa J, Nishiyama K, Komori M (2014) A Prospective, Randomized, Blinded Trial to Compare Continuous Epidural Block and Femoral Nerve Block for Total Knee Arthroplasty. J Anesth Clin Res 5:410. doi: 10.4172/2155-6148.1000410
Copyright: © 2014 Kodaka M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Objective: We conducted a prospective, randomized, and blinded trial to compare the perioperative quality of anesthesia and analgesia for Total Knee Arthroplasty (TKA) using either Epidural Analgesia (EA) or ultrasoundguided continuous Femoral Nerve Block (FNB).
Methods: Forty patients scheduled for TKA were randomized to two groups, EA or FNB. The initial local anesthetic doses for EA and FNB blocks were 5 mL and 20 mL 0.5% ropivacaine, respectively. After epidural or femoral nerve sheath catheterization, patients were anesthetized using propofol infusion and air-mixed 40% oxygen. A ProSealTM laryngeal mask airway was inserted and intravenous fentanyl was used as supplementary analgesia if necessary. After surgery, patients in both groups were administered an infusion of 4 mL/h 0.2% ropivacaine and 12.5 μg/h fentanyl via the epidural or femoral nerve catheter. We recorded the total doses of fentanyl administered during surgery, and the extent of postoperative pain using a visual analog scale (VAS) at rest and on movement until the third postoperative day (POD3).
Results: The mean doses of fentanyl administered during surgery in the EA and FNB groups were 106.6 ± 45.8 μg and 232.5 ± 84.7 μg, respectively [mean ± standard deviation; p < 0.0001]. Significantly lower VAS pain scores were reported during movement in the EA group on POD1 [EA vs. FNB=23 (0-77) vs. 47 (0-100), p=0.027] and POD2 [43 (0-70) vs. 63 (15-100), p=0.031].
Conclusions: Continuous epidural analgesia requires less fentanyl for TKA than FNB and is more effective for postoperative pain on movement.