Anesthesiology News—June 1, 2012
Three new studies presented at the 2012 annual meeting of the American Academy of Orthopaedic Surgeons highlighted the advantages of femoral blocks over other anesthetic approaches in these patients. They showed that femoral blockade can spare patients from opioid-related adverse effects, reduce the need for joint manipulation after surgery and hasten discharge from the postanesthesia care unit (PACU).
Femoral Blockade Versus Periarticular Injection
One of the studies (abstract P201) compared two widely used protocols for perioperative pain management after total knee arthroplasty (TKA). The prospective, randomized controlled trial enrolled 90 patients. Half received epidural analgesia plus femoral nerve block (PCEA/FNB); the rest received periarticular injections plus oral opioids (PAI).
Patients in both protocols had similar lengths of stay in the hospital and similar postoperative pain scores. However, patients who received PCEA/FNB reported significantly less pain with ambulation on postoperative day 1, and less pain with regard to quality of recovery. Patients in both groups reported similar pain levels on the second and third days after surgery. The researchers also found no significant differences between the groups in global quality of recovery scores, patient satisfaction or opioid intake.
“We were surprised that PAI worked almost as well as PCEA/FNB,” said Geoffrey H. Westrich, M.D., orthopedic surgeon at Hospital for Special Surgery in New York City, who presented the research. “We can now tell smaller hospitals that don’t have our level of expertise that PAI works extremely well; much better than just giving pain pills after surgery.”
The PAI approach also is less expensive than PCEA/FNB, and Dr. Westrich noted that he would consider trying the protocol in his surgical practice. However, he added, a multimodal approach to pain management works best.
“One of the most common concerns patients have is how much pain they’ll experience and how we’ll treat it. They like the control they have with a pain pump,” he said.
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