Abstract:
BACKGROUND:Both femoral and obturator nerve blocks have been suggested to be useful in relieving pain after total knee arthroplasty (TKA). We sought to compare their efficacy. METHODS:Sixty patients undergoing elective unilateral TKA under spinal anesthesia received in a randomized, double-blind manner a femoral, obturator, or sham nerve block at the end of surgery. Blocks were performed using nerve stimulation and 20 mL bupivacaine 0.5% containing epinephrine 5 microg/mL. Patient-controlled IV analgesia with fentanyl, celecoxib 100 mg PO bid, and acetaminophen 650 mg PO every 6 h were started on arrival in the recovery room. Pain (0-10 numeric rating scale, NRS) at rest and with movement, analgesic use, and side effects were recorded for 48 h. Maximum knee flexion and total days in hospital were recorded as functional outcomes. RESULTS:There were no significant differences in the obturator block group and the control group in any outcome variable. With baseline pain scores subtracted, femoral block resulted in less pain at rest compared with control (NRS difference from baseline 2.1 +/- 0.4 sem vs 3.4 +/- 0.4, respectively; P = 0.02) and less pain with movement (NRS difference 2.6 +/- 0.6, 4.3 +/- 0.6, P = 0.05) at recovery room discharge. Neither block had a significant effect on opioid use, functional outcome, or side effects. Only one (5%) patient with femoral block developed obturator motor block. CONCLUSION:Femoral nerve blocks rarely block the obturator nerve. Single-injection femoral nerve block improved multimodal analgesia after spinal anesthesia for TKA, but this effect did not persist beyond the day of surgery. Obturator nerve block alone was of no benefit.
journal_name
Anesth Analgjournal_title
Anesthesia and analgesiaauthors
Kardash K,Hickey D,Tessler MJ,Payne S,Zukor D,Velly AMdoi
10.1213/01.ane.0000278158.36843.f7subject
Has Abstractpub_date
2007-09-01 00:00:00pages
853-8issue
3eissn
0003-2999issn
1526-7598pii
105/3/853journal_volume
105pub_type
杂志文章,随机对照试验abstract:UNLABELLED:We determined whether two different devices for measuring near-infrared spectroscopy (NIRS)---the INVOS 4100 and the NIRO 300---produce similar cerebral oxygenation data during the CO(2) challenge test. Nineteen patients anesthetized with sevoflurane, 67% nitrous oxide in oxygen, and fentanyl were studied. A...
journal_title:Anesthesia and analgesia
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journal_title:Anesthesia and analgesia
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journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
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