Abstract ID: A22

Abstract Title: Femoral block for total knee replacement

Poster Type: Either

ABSTRACT BODY

Introduction: Total knee replacement is associated with severe postoperative pain and a significant incidence of DVT. Several methods of pain control have been cited in the literature, including systemic narcotics, epidural anesthesia, femoral nerve block(1), sciatic nerve block(2), and femoral catheter infusion(1). Although epidural anesthesia is the most effective pain control method, it is associated with side effects, and, in anticoagulated patients, can lead to epidural hematoma, a rare but devastating complication. Finding a method of effective pain control with minimal side effects is a desired goal. We try to determine if a bolus of local anesthetic trough a femoral catheter is safe and effective in control pain after tkr compared to epidural analgesia

Materials and Methods:After approval- of the Medical Ethic Committee 87 patients were enrolled in the study and divided in four groups:
1. Femoral catheter bolus of 30cc of bupivacaine 0.375% with epinephrine 1:200,000 in the OR and bolus of the same local anesthesic the first postop day
2. epidural catheter infusion for 24 hours, with femoral catheter bolus of local anesthesic after removal of epidural catheter.
3. Epidural catheter infusion for 24 hours.
4. Epidural catheter infusion for 48 hours.
Groups 1, 2, and 3 will have a morphine IVPCA.
All the groups had combined spinal epidural and IV sedation for the surgery.

Results: Of the four groups, the best pain control was achieved by epidural infusion for 48 hours (group 4) and femoral catheter(group 1). However, 75% of patients with an epidural infusion required catheterization for urinary retention as compared to 25% with femoral catheter
There were no failures in the femoral block group, with the epidural block failing in 20% of patients.

Discussion: the placement of a femoral catheter and deliver of local anesthesic as a bolus is safe, there is no need of an infusion pump with better catheter fixation and less catheter problems (dislodge, kinking) and with morphine IVPCA provides a reliable and effective alternate method of pain control, with a lower incidence of urinary retention

References:1-Singelyn,Deyaert. Effects of intravenous patient controlled analgesia with morphine, continuos epidural analgesia, and continuous three in one block on postoperative pain and knee rehabilitation after unilateral total knee arthroplasty.Anesth analg :1998,87:88-92
2-Allen HW, Spencer LS peripheral nerve blocks improve analgesia after total knee replacement surgery.Anesth analgesia 1998;87:93-97

ATTACHED FILES

Reg Anesth Pain Med 2004; 29(2):A22