Title: A comparative study of Ultrasound Guided Continuous Femoral Nerve Block Versus Local Infiltration Analgesia for management of postoperative Pain in Unilateral Total Knee Arthroplasty in an Indian scenario
Authors: Dr Deepika Chaubey, Dr Abhishek Dwivedi, Dr P R Chauha, Dr Preeti S Govind, Dr H K Mahajan, Dr Shalu Singh, Dr Abhinav Gupta, Dr Mohit Saini
DOI: https://dx.doi.org/10.18535/jmscr/v5i7.210
Abstract
Introduction: Use of local infiltration in knee joint arthroplasty, provide postoperative analgesia and preserves motor power of quadriceps, which helps in early mobilisation, as compared to femoral nerve block which paralyses vastus medialis
Aim: To compare the application of postoperative analgesia provided by ultrasound guided femoral nerve block and local infiltration in unilateral total knee replacement
Material and Methods: A prospective study was conducted on 60 patients between 25 – 65years of ASA I and II, which were randomly(using random number table) divided into two groups – group 1-femoral nerve block (FNB) and group 2-local infiltration analgesia(LIA). Patients with chronic pain and on opioids were excluded. (power> 80%) Numeric rating scale (primary objective), sedation score, nausea vomiting score and motor power were analysed.
Result: Pain relief was better in FNB group (p value <.001) with less fentanyl demand (p value <.001) ,low sedation score and low nausea vomiting scoring but associated with low muscle power grading
Conclusion: FNB has better pain relief than LIA group but range of motion was reduced in FNB group.
Keywords: Local infliltration, inotrophy, opoids.
References
- Ropivacaine: A review of its pharmacology and clinical use Gaurav Kuthiala and Geeta Chaudhary Gaurav Kuthiala and Geeta Chaudhary IJR Vol 55 Mar-Apr 2011(2) 105-109.
- Hansen TG Expert Rev Neurother. 2004 Sep; 4(5):781-91
- Toxicological and local anesthetic effects of optically active isomers of two local anaesthetic compounds. Aberg G Acta Pharmacol Toxicol (Copenh). 1972; 31(4):273-86.
- McClure JH Br J Anaesth. 1996 Feb; 76(2):300-7.
- Kindler CH, Paul M, Zou H, Liu C, Winegar BD, Gray AT, Yost CS J Pharmacol Exp Ther. 2003 Jul; 306(1):84-92.
- Graf BM, Abraham I, Eberbach N, Kunst G, Stowe DF, Martin E Anesthesiology. 2002 Jun; 96(6):1427-34
- Dony P, Dewinde V, Vanderick B, Cuignet O, Gautier P, Legrand E, Lavand'homme P, De Kock M The comparative toxicity of ropivacaine and bupivacaine at equipotent doses in rats.Anesth Analg. 2000 Dec; 91(6):1489-92.
- Knudsen K, Beckman Suurküla M, Blomberg S, Sjövall J, Edvardsson N .[Central nervous and cardiovascular effects of i.v. infusions of ropivacaine, bupivacaine and placebo in volunteers. Br J Anaesth. 1997 May; 78(5):507-14.
- Graf BM Curr The cardiotoxicity of local anesthetics: the place of ropivacaine Top Med Chem. 2001 Aug; 1(3):207-14.
- Cederholm I, Evers H, Löfström JB Skin blood flow after intradermal injection of ropivacaine in various concentrations with and without epinephrine evaluated by laser Doppler flowmetry.Reg Anesth. 1992 Nov-Dec; 17(6):322-8.
- Porter J, Crowe B, Cahill M, Shorten G The effects of ropivacaine hydrochloride on platelet function: an assessment using the platelet function analyser (PFA-100).Anaesthesia. 2001 Jan; 56(1):15-8.
- Simpson D, Curran MP, Oldfield V, Keating GM Drugs. 2005; 65(18):2675-717.
- Burm AG, Stienstra R, Brouwer RP, Emanuelsson BM, van Kleef JW Anesthesiology. 2000 Aug; 93(2):395-403location]
- Ekström G, Gunnarsson UBDrug Metab Dispos. 1996 Sep; 24(9):955-61.
- Selander D, Sjovall J, Waldenlind L. Accidental i.v injections of ropivacaine: Clinical experience of six cases [abstract] Reg Anaesth. 1997;22:70
- Jokinen MJ, Olkkola KT, Ahonen J, Neuvonen PJ Clin Pharmacol Ther. 2001 Oct; 70(4):344-50.
- Cpogna G,Celleno D,Fusco P,Lyons G,Columb M.Relative potencies of bupivicaine and ropivicaine for analgesia in labour Br J Anaesth 1999;82:371±3.
- Polley LS ,Columb MO,Naughton NN ,Wagner DS, CosmasJM Relative analgesic potencies of ropivicaine and bupivicaine for epidural analgesia in labour.Anaesthesiology 1999;90 944±50.
- Crosby E, Sandler A, Finucane B, Writer D, Reid D, McKenna J, Friedlander M, Miller A, O'Callaghan-Enright S, Muir H, Shukla R Can J Anaesth. 1998 Nov; 45(11):1066-71.
- Peduto VA, Baroncini S, Montanini S, Proietti R, Rosignoli L, Tufano R, Casati A Eur J Anaesthesiol. 2003 Dec; 20(12):979-83.