A comparison of continuous femoral nerve block combined with sciatic nerve block and epidural analgesia for postoperative pain management after total knee replacement

ABSTRACT

BACKGROUND: Epidural analgesia (EPA) has been used for postoperative pain control in total knee replacement (TKR). However, many patients have suffered various side effects after epidural blockade. Peripheral nerve block (PNB) has been shown to provide effective pain relief after TKR. We compared the benefits of continuous femoral nerve block (FNB) combined with single-injection sciatic nerve block (SNB) with those of EPA for postoperative pain management after TKR. METHODS: Eighty participants undergoing unilateral TKR were randomized to receive either EPA (EPA group) or continuous FNB combined with SNB (PNB group). All patients received general anesthesia for TKR. Ropivacaine 2 mg/ml plus fentanyl 2 µg/ml was administered for EPA. Ropivacaine 2 mg/ml was administered through the femoral nerve catheter. The pain score, side effects (dizziness, sedation, nausea, vomiting, pruritus, hypotension and urinary retention), motor blockade, knee range of motion, and rehabilitation were measured postoperatively. The primary outcome measure was the number of patients experiencing side effects. RESULTS: The incidence of patients with side effects was 86.8% in the EPA group but only 35.1% in the PNB group (P < 0.001). There were no significant differences between the two groups in terms of pain score, motor blockade of the operative limb, knee range of motion, or rehabilitation. CONCLUSIONS: Continuous FNB combined with SNB can be an effective alternative to EPA for postoperative pain management in TKR.