Multimodal analgesia after total knee arthroplasty

doi:10.3969/j.issn.2095-4344.2013.22.003

Abstract

Abstract:

BACKGROUND: Perioperative pain management is the focus in total knee arthroplasty. Looking for a safe and effective analgesic way has become one of the important tasks of the surgeons.
OBJECTIVE: To compare the analgesia and rehabilitation effect of the epidural analgesia and the femoral nerve analgesia after total knee arthroplasty, and to explore the relative multimodal analgesia proposal.
METHODS: Forty patients undergoing unilateral total knee arthroplasty were randomly selected, and the patients were divided into two groups according to different analgesia proposals: epidural analgesia group and femoral nerve analgesia group, 20 patients in each group. All patients received unilateral total knee arthroplasty and preoperative missionary and celecoxib administration under epidural analgesia. Patients in the epidural analgesia group were given analgesia with 0.2% ropivacaine and 2 ug/mL fentanyl after the replacement. The patients in the femoral nerve analgesia group were given analgesia with 0.2% popivacaine from the femoral nerve block vessel. The visual analog scores of the patients were observed at 6, 12 and 24 hours and 2-7 days after total knee arthroplasty, and the range of motion was recorded at 2-7 days after total knee arthroplasty.
RESULTS AND CONCLUSION: At 2-7 days after total knee arthroplasty, the visual analog scores of rest/movement pain were decreased in two groups, and the pain degree in the femoral nerve analgesia group was smaller than that in the epidural analgesia group. At 2-7 days after total knee arthroplasty, the range of motion of the patients in two groups was increased gradually, and the range of motion in the femoral nerve analgesia group was larger than in the epidural analgesia group. The results showed that both the epidural analgesia and the femoral nerve analgesia can relieve pain after total knee arthroplasty, but the femoral nerve analgesia can provide better pain relief than epidural analgesia, and it can lead to a quick functional recovery. Multimodal analgesia proposal can effectively control the pain.

Key words: bone and joint implants, artificial prosthesis, total knee arthroplasty, epidural analgesia, nerve block, femoral nerve, multimodal analgesia, ropivacaine, rehabilitation, provincial grants-supported paper

CLC Number:

R318

','1');return false;" target="_blank">

R318

Liu Bing-shan, Li Guo-jun, Wang Xiao, Zhang Song, Liu Yang, Zhang Yong-le. Multimodal analgesia after total knee arthroplasty[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(22): 4005-4012.

Figures/Tables 5

References

[1]Li DW, Xu Y, Wu HS. Shiyong Yixue Zazhi. 2007;23(18): 2814-2815.李东文,徐燕,吴海山.全膝关节置换术围手术期疼痛控制现状及思考[J].实用医学杂志,2007,23(18):2814-2815.

[2]Zhang YL, Xie XX, Yan SX. Zhongguo Yiyao Daobao. 2007; 4(29):61-62. 张亚丽,谢秀霞,闫淑霞.人工全髋关节置换术围术期病人的护理[J].中国医药导报,2007,4(29):61-62.

[3]Allen HW, Liu SS, Ware PD, et al. Peripheral nerve blocks improve analgesia after total knee replacement surgery. Anesth Analg. 1998;87(1):93-97.

[4]Szczukowski MJ Jr, Hines JA, Snell JA, et al. Femoral nerve block for total knee arthroplasty patients: a method to control postoperative pain. J Arthroplasty. 2004;19(6):720-725.

[5]Mahoney OM, Noble PC, Davidson J, et al. The effect of continuous epidural analgesia on postoperative pain, rehabilitation, and duration of hospitalization in total knee arthroplasty. Clin Orthop Relat Res. 1990;(260):30-37.

[6]Fowler SJ, Symons J, Sabato S, et al. Epidural analgesia compared with peripheral nerve blockade after major knee surgery: a systematic review and meta-analysis of randomized trials. Br J Anaesth. 2008;100(2):154-164.

[7]Shanthanna H, Huilgol M, Manivackam VK, et al. Comparative study of ultrasound-guided continuous femoral nerve blockade with continuous epidural analgesia for pain relief following total knee replacement. Indian J Anaesth. 2012; 56(3):270-275.

[8]Tantry TP, B G M, Hukkery R. Use of a single injection femoral nerve block in the patients of total knee replacement with concomitant epidural analgesia. J Clin Diagn Res. 2012;6(10): 1744-1748.

[9]Osawa M, Takahama Y, Kondo Y. Comparison of postoperative pain relief by continuous femoral nerve block and that by epidural block during physiotherapy after minimally invasive surgery of total knee arthroplasty and uni-condylar knee arthroplasty. Masui. 2012;61(12): 1316-1323.

[10]Ishiguro S, Yokochi A, Yoshioka K, et al. Technical communication: anatomy and clinical implications of ultrasound-guided selective femoral nerve block. Anesth Analg. 2012;115(6):1467-1470.

[11]Dorr LD, Raya J, Long WT, et al. Multimodal analgesia without parenteral narcotics for total knee arthroplasty. J Arthroplasty. 2008;23(4):502-508.

[12]Ranawat AS, Ranawat CS. Pain management and accelerated rehabilitation for total hip and total knee arthroplasty. J Arthroplasty. 2007;22(7 Suppl 3):12-15.

[13]Kim JH, Cho MR, Kim SO, et al. A comparison of femoral/sciatic nerve block with lateral femoral cutaneous nerve block and combined spinal epidural anesthesia for total knee replacement arthroplasty. Korean J Anesthesiol. 2012; 62(5):448-453.

[14]Zongxing WZZ. Tengtong Yixue Zazhi. 1994,2(4):153-155.宗行万之助.疼痛的估价——用特殊的视觉模拟评分法作参考(VAS)[J].疼痛学杂志,1994,2(4):153-155.

[15]Guan ZP, Lv HS, Wu C, et al. Zhonghua Waike Zazhi.2003; 41:37-40.关振鹏,吕厚山,吴淳,等.人工关节置换术后肺栓塞的早期诊断和处理[J].中华外科杂志,2003,41:37-40.

[16]Li L, Luo M, Feng J. Zhongguo Jiaoxing Waike Zazhi. 2009;17: 1139-1141.李丽,罗曼,冯洁,等.连续股神经阻滞镇痛对老年人全膝关节置换术后康复功能的影响[J].中国矫形外科杂志,2009,17:1139- 1141.

[17]Abdallah FW, Brull R. Is sciatic nerve block advantageous when combined with femoral nerve block for postoperative analgesia following total knee arthroplasty? A systematic review. Reg Anesth Pain Med. 2011;36(5):493-498.

[18]Affas F, Nygårds EB, Stiller CO, et al. Pain control after total knee arthroplasty: a randomized trial comparing local infiltration anesthesia and continuous femoral block. Acta Orthop. 2011;82(4):441-447.

[19]Asakura Y, Tsuchiya H, Mori H, et al. Reduction of the incidence of development of venous thromboembolism by ultrasound-guided femoral nerve block in total knee arthroplasty. Korean J Anesthesiol. 2011;61(5):382-387.

[20]Asakura Y, Yano T, Takagi H, et al. The incidence of development of motor blockade by ropivacaine is concentration dependent, and most studies regarding the continuous FNB after total knee arthroplasty used 0.2% to 0.3%ropivacaine. J Arthroplasty. 2010;25(5):836; author reply 837-838.

[21]Aveline C, Le Roux A, Le Hetet H, et al. Postoperative efficacies of femoral nerve catheters sited using ultrasound combined with neurostimulation compared with neurostimulation alone for total knee arthroplasty. Eur J Anaesthesiol. 2010;27(11):978-984.

[22]Baranovi? S, Maldini B, Milosevi? M, et al. Peripheral regional analgesia with femoral catheter versus intravenous patient controlled analgesia after total knee arthroplasty: a prospective randomized study. Coll Antropol. 2011;35(4): 1209-1214.

[23]Jia DL, Li SQ, Yu JK, et al. Zhongguo Tengtong Yixue Zazhi. 2008;14:214-217.贾东林,李水清,余家阔,等.罗哌卡因或利多卡因持续股神经阻滞用于膝关节置换术后患者康复镇痛的临床研究[J].中国疼痛医学杂志,2008,14:214-217.

[24]Nader A, Kendall MC, Wixson RL, et al. A randomized trial of epidural analgesia followed by continuous femoral analgesia compared with oral opioid analgesia on short- and long-term functional recovery after total knee replacement. Pain Med. 2012;13(7):937-947.

[25]Sugar SL, Hutson LR Jr, Shannon P, et al. Comparison of extended-release epidural morphine with femoral nerve block to patient-controlled epidural analgesia for postoperative pain control of total knee arthroplasty: a case-controlled study. Ochsner J. 2011;11(1):17-21.

[26]Barker MC. Combined spinal/general anesthesia with postoperative femoral nerve block for total knee replacement in a patient with familial hyperkalemic periodic paralysis: a case report. AANA J. 2010;78(3):191-194.

[27]Barrington MJ, Olive DJ, McCutcheon CA, et al. Stimulating catheters for continuous femoral nerve blockade after total knee arthroplasty: a randomized, controlled, double-blinded trial. Anesth Analg. 2008;106(4):1316-1321, table of contents.

[28]Scott DA, Chamley DM, Mooney PH, et al. Epidural ropivacaine infusion for postoperative analgesia after mafor lower abdominal surgery-a dose finding study. Anesth Analg. 1995;81:982-986.

[29]Zhonghua Yixuehui Guke Fenhui. Zhongguo Shequ Yishi. 2012;21(28):13.中华医学会骨科学分会.骨科常见疼痛的处理专家建议[J].中国社区医师,2012,21(28):13.

[30]Johnson CB, Steele-Moses SK. The use of continuous femoral nerve blocks versus extended release epidural morphine: a study comparing outcomes in total knee arthroplasty procedures. Orthop Nurs. 2011;30(1):44-53.

[31]Yadeau JT, Liu SS, Rade MC, et al. Performance characteristics and validation of the Opioid-Related Symptom Distress Scale for evaluation of analgesic side effects after orthopedic surgery. Anesth Analg. 2011;113(2): 369-377.

[32]Lee AR, Choi DH, Ko JS, et al. Effect of combined single-injection femoral nerve block and patient-controlled epidural analgesia in patients undergoing total knee replacement. Yonsei Med J. 2011;52(1):145-150.

[33]Beaupre LA, Johnston DB, Dieleman S, et al. Impact of a preemptive multimodal analgesia plus femoral nerve blockade protocol on rehabilitation, hospital length of stay, and postoperative analgesia after primary total knee arthroplasty: a controlled clinical pilot study. Scientific World J. 2012;2012:273821.

[34]Bunburaphong P, Niruthisard S, Werawatganon T, Postoperative analgesia for total knee replacement: comparing between pre-and postoperative "3-in-1" femoral nerve block. J Med Assoc Thai. 2006;89(4):462-467.

[35]Skinner HB, Shintani EY. Results of a multimodal analgesic trial involving patients with total hip or total knee arthroplasty. Am J Orthop. 2004;33(10):85-88.

[36]Berend KR, Lombardi Jr AV, Mallory TH. Rapid recovery protocol for preoperative care of total hip and total knee arthroplasty patients. ClinOrthop Relat Res. 2004;11(429): 239-411.

[37]Li DW, Xu Y, Wu HS. Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu. 2007;11(36):7223-7226.李东文,徐燕,吴海山.全膝关节置换术后多模式围手术期疼痛控制方案在镇痛中的作用评价[J]. 中国组织工程研究与临床康复, 2007,11(36):7223-7226.

[38]Cao F, Li CY, Kang XH. Zhongguo Xiandai Yisheng. 2009; 47(9): 50-52.曹飞,李超艺,康小红.人工全膝关节置换围手术期多模式联合镇痛的临床研究[J].中国现代医生,2009,47(9):50-52.

[39]Zhu YL, Wu HS, Wu YL. Shiyong Guke Zazhi. 2009;15(2): 86-88.祝云利,吴海山,吴宇黎.全膝关节置换术围手术期复合镇痛疗效观察[J].实用骨科杂志,2009,15(2):86-88.

[40]Zhang Y, Qian QR. Linchuang Junyi Zazhi. 2009;37(2): 320-323.张阳,钱齐荣.COX-2抑制剂与全膝关节置换术围术期镇痛[J].临床军医杂志,2009,37(2):320-323.

[41]Wang HJ, Zhang DZ, Li SZ. Comparing the analgesic efficacy of continuous femoral nerve blockade and continuous intravenous analgesia after total knee arthroplasty. Zhonghua Yi Xue Za Zhi. 2010;90(33):2360-2362.

[42]Paul JE, Arya A, Hurlburt L, et al. Femoral nerve block improves analgesia outcomes after total knee arthroplasty: a meta-analysis of randomized controlled trials. Anesthesiology. 2010;113(5):1144-1162.

[43]Meunier A, Lisander B, Good L. Effects of celecoxib on blood loss,pain, and recovery of function after total knee replacement: a randomized placebo-controlled trial. Acta Orthop. 2007;78(5):661-667.

[44]Reuben SS, Buvenandran A, Katz B, et al. A prospective randomized trial on the role of perioperative celecoxib administration for total knee arthroplasty: improving clinical outcomes. Anesth Analg. 2008;106(4):1258-1264.

[45]Sundarathiti P, Ruananukul N, Channum T, et al. A comparison of continuous femoral nerve block (CFNB) and continuous epidural infusion (CEI) in postoperative analgesia and knee rehabilitation after total knee arthroplasty (TKA). J Med Assoc Thai. 2009;92(3):328-334.

[46]Huang YM, Wang CM, Wang CT, et al. Perioperative celecoxib administration for pain management after total knee arthroplasty-a randomized, controlled study. BMC Musculoskelet Disord. 2008;9:77.

[47]Cappelleri G, Ghisi D, Fanelli A, et al. Does continuous sciatic nerve block improve postoperative analgesia and early rehabilitation after total knee arthroplasty? A prospective, randomized, double-blinded study. Reg Anesth Pain Med. 2011; 36(5):489-492.

[48]Chan MH, Chen WH, Tung YW, et al. Single-injection femoral nerve block lacks preemptive effect on postoperative pain and morphine consumption in total knee arthroplasty. Acta Anaesthesiol Taiwan. 2012;50(2):54-58.

[49]Fu ZG, Qu YX, Mu XF. Zhongguo Tengtong Yixue Zazhi. 2009; 15(3):191-192.伏治国,瞿玉兴,牟晓峰.关节局部注射对全膝关节置换术后镇痛23例报告[J].中国疼痛医学杂志,2009,15(3):191-192.

[50]Gao ZY, Wang YZ, Xu HM, et al. Zhongguo Jiaoxing Waike Zazhi. 2009;17(9):654-657.高正玉,王英振,徐红梅,等.膝关节局部注药在全膝关节置换镇痛中的应用[J].中国矫形外科杂志,2009,17(9):654-657.