Elsevier

The Journal of Arthroplasty

Volume 21, Issue 8, December 2006, Pages 1111-1117
The Journal of Arthroplasty

Original Article
A Pilot Study on Continuous Femoral Perineural Catheter for Analgesia After Total Knee Arthroplasty: The Effect on Physical Rehabilitation and Outcomes

https://doi.org/10.1016/j.arth.2005.12.005Get rights and content

Two techniques of postoperative analgesia for primary total knee arthroplasty were compared retrospectively. Twenty-four patients received a femoral nerve catheter with continuous infusion of ropivacaine (FNC group), whereas 26 patients received intravenous (IV) opioids (IV opioid group). Pain and rehabilitation scores and hospital length of stay (LOS) were compared. On the first postoperative day, both groups reported similar pain scores. After 4 sessions of twice-daily rehabilitation, the FNC group used less IV patient-controlled opioids (29.1% vs 84.5%, P = .0001) and demonstrated better performance with knee flexion and mobility. Hospital LOS was significantly less in the FNC group (3.6 vs 4.2 days, P = .034). Femoral nerve catheters with continuous infusion of ropivacaine provide satisfactory analgesia, improve rehabilitation, and shorten hospital LOS.

Section snippets

Materials and Methods

The study population was recruited among consecutive patients who underwent a primary, elective, unilateral TKA for degenerative joint disease between June 2001 and September 2002 by 7 orthopedic surgeons and 4 anesthesiologists. Patients with a contraindication to either opioid analgesia or peripheral nerve block (eg, preoperative anticoagulation) were excluded. In accordance with the institutional review board, patients not giving permission for a retrospective case study were excluded.

Statistical Analysis

Statistical analysis was performed using SPSS 11.0 software (SPSS Inc, Chicago, Ill). Statistical comparisons were performed using the t test for parametric data, Mann-Whitney U test for rank order data, and Fisher's exact probability analysis for categorical data. Statistical significance levels were set at P < .05. A correlation analysis was performed within each group between self-reported pain scores and case order number (ie, ordered by date, where r1 = first case, r2 = second case, etc,

Results

There were 24 patients in the FNC group and 26 patients in the IV opioid group, 50 patients in total. Patient demographics are shown in Table 3. In the IV opioid group (n = 26), 19 patients received an epidural anesthetic, 5 patients received a general anesthetic, and 2 patients received a spinal anesthetic. In the FNC group (n = 4), 17 patients received a spinal anesthetic and 7 patients received a general anesthetic. No patient received both a combined epidural and FNC. Pain scores recorded

Discussion

Severe pain after TKA has been associated with poor functional recovery 7, 8. Studies have demonstrated improved analgesia after TKA via continuous femoral perineural catheter infusion as compared with IV opioid administration 9, 10. The aim of this study was to assess the effect of analgesia techniques after TKA on physical rehabilitation and outcomes. Physical therapists recorded patients' VAS pain scores immediately before the commencement of their first physical therapy session on POD 1.

Conclusion

In TKA, analgesia and physical therapy are stressed early after surgery, with the aim of improving rehabilitation and decreasing length of hospitalization. In our study, both groups reported equivalent analgesia; however, the FNC group had improved postoperative knee flexion, decreased assistance requirements in functional measurement of mobility, and decreased hospital LOS as compared with the IV opioid group. Further work is needed to study the specific effect of femoral perineural catheter

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No Benefits or funds were received in support of the study.

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