Document Detail

Femoral nerve block improves analgesia outcomes after total knee arthroplasty: a meta-analysis of randomized controlled trials.
MedLine Citation:
PMID:  20966667     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Femoral nerve blockade (FNB) is a common method of analgesia for postoperative pain control after total knee arthroplasty. We conducted a systematic review to compare the analgesia outcomes in randomized controlled trials that compared FNB (with and without sciatic nerve block) with epidural and patient-controlled analgesia (PCA).
METHODS: We identified 23 randomized controlled trials that compared FNB with PCA or epidural analgesia. These studies included 1,016 patients, 665 with FNB, 161 with epidural, and 190 with PCA alone.
RESULTS: All 10 studies of single-shot FNB (SSFNB) used concurrent PCA opioids. SSFNB was found to reduce PCA morphine consumption at 24 h (-19.9 mg, 95% credible interval [CrI]: -35.2 to -4.6) and 48 h (-38.0 mg, 95% CrI: -56.0 to -19.7), pain scores with activity (but not at rest) at 24 and 48 h (-1.8 visual analog pain scale, 95% CrI: -3.3 to -0.02 at 24 h; -1.5 visual analog pain scale, 95% CrI: -2.9 to -0.02 at 48 h) and reduce the incidence of nausea (0.37 odds ratio, 95% CrI: 0.1 to 0.9) compared with PCA alone. SSFNB had similar morphine consumption and pain scores compared with SSFNB plus sciatic nerve block, and SSFNB plus continuous FNB.
CONCLUSIONS: SSFNB or continuous FNB (plus PCA) was found to be superior to PCA alone for postoperative analgesia for patients having total knee arthroplasty. The impact of adding a sciatic block or continuous FNB to a SSFNB needs to be studied further.
James E Paul; Aman Arya; Lindsay Hurlburt; Ji Cheng; Lehana Thabane; Antonella Tidy; Yamini Murthy
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Publication Detail:
Type:  Comparative Study; Journal Article; Meta-Analysis; Review    
Journal Detail:
Title:  Anesthesiology     Volume:  113     ISSN:  1528-1175     ISO Abbreviation:  Anesthesiology     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-10-22     Completed Date:  2010-11-09     Revised Date:  2011-07-13    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1144-62     Citation Subset:  AIM; IM    
Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada.
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MeSH Terms
Analgesia / methods
Analgesia, Patient-Controlled* / methods
Arthroplasty, Replacement, Knee* / methods
Femoral Nerve* / physiology
Nerve Block* / methods
Pain Measurement / methods
Pain, Postoperative / prevention & control
Randomized Controlled Trials as Topic* / methods
Treatment Outcome
Comment In:
Anesthesiology. 2011 Jun;114(6):1494-5; author reply 1495   [PMID:  21610464 ]
Anesthesiology. 2010 Nov;113(5):1014-5   [PMID:  20881593 ]

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