JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (12) Citing Articles via Google Scholar Google Scholar Articles by Salinas, F. V. Articles by Mulroy, M. F. Search for Related Content PubMed PubMed Citation Articles by Salinas, F. V. Articles by Mulroy, M. F. Related Collections Economics and Health Care Research Regional Anesthesia

---

REGIONAL ANESTHESIA

The Effect of Single-Injection Femoral Nerve Block Versus Continuous Femoral Nerve Block After Total Knee Arthroplasty on Hospital Length of Stay and Long-Term Functional Recovery Within an Established Clinical Pathway

Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington; and Department of Anesthesiology, University of Washington, Seattle

Address correspondence and reprint requests to Dr. Francis V. Salinas, Department of Anesthesiology, Virginia Mason Medical Center, 1100 9th Avenue (Mailstop B2-AN), Seattle, WA 98101. Address e-mail to: anefvs{at}vmmc.org.

Total knee arthroplasty (TKA) may result in severe pain, and single-injection femoral nerve blocks (SFNB) have been demonstrated to have a limited duration of analgesia. Continuous femoral nerve blocks (CFNB) can prolong the analgesic duration of SFNB. We prospectively randomized 36 patients undergoing TKA to CFNB versus SFNB and evaluated the effect on hospital length of stay (LOS) as the primary outcome within a standardized clinical pathway. Secondary outcomes included visual analog scale (VAS) pain scores, opioid consumption, and long-term functional recovery at 12 wk. Mean VAS resting scores were significantly lower among patients who received CFNB versus SFNB: first day (1.7 vs 3.3 [P = 0.002]) and second day (0.9 vs 3.2 [P < 0.0001]) after surgery. Mean maximal VAS scores during physical therapy were significantly lower among patients who received CFNB versus SFNB: first day (4.7 vs 6.3 [P = 0.01]) and second day (3.9 vs 6.1 [P = 0.0005]) after surgery. Mean oxycodone consumption was significantly lower among patients who received CFNB versus SFNB: 15 mg versus 40 mg (P = < 0.0001) on the first day after surgery; 20 mg versus 43 mg (P = 0.0004) on the second day after surgery. There was no difference in hospital LOS (3.8 vs 3.9 days) or long-term functional recovery (117° versus 113° knee flexion at 12 wk) between the two groups. The lack of effect provided by increased duration of analgesia (from CFNB) after TKA may now have minimal impact on hospital LOS and long-term functional recovery in the contemporary healthcare environment within the United States.

This article has been cited by other articles:

				M. J. Barrington, D. J. Olive, C. A. McCutcheon, C. Scarff, S. Said, R. Kluger, N. Gillett, and P. Choong Stimulating Catheters for Continuous Femoral Nerve Blockade After Total Knee Arthroplasty: A Randomized, Controlled, Double-Blinded Trial Anesth. Analg., April 1, 2008; 106(4): 1316 - 1321. [Abstract] [Full Text] [PDF]

				S. J. Fowler, J. Symons, S. Sabato, and P. S. Myles Epidural analgesia compared with peripheral nerve blockade after major knee surgery: a systematic review and meta-analysis of randomized trials Br. J. Anaesth., February 1, 2008; 100(2): 154 - 164. [Abstract] [Full Text] [PDF]

				S. S. Liu and C. L. Wu The Effect of Analgesic Technique on Postoperative Patient-Reported Outcomes Including Analgesia: A Systematic Review Anesth. Analg., September 1, 2007; 105(3): 789 - 808. [Abstract] [Full Text] [PDF]

				K. Kardash, D. Hickey, M. J. Tessler, S. Payne, D. Zukor, and A. M. Velly Obturator Versus Femoral Nerve Block for Analgesia After Total Knee Arthroplasty Anesth. Analg., September 1, 2007; 105(3): 853 - 858. [Abstract] [Full Text] [PDF]

				D. Zaric, K. Boysen, C. Christiansen, J. Christiansen, S. Stephensen, and B. Christensen Combined Femoral-Sciatic Catheters for Postoperative Pain Treatment After Total Knee Replacement Anesth. Analg., July 1, 2007; 105(1): 288 - 289. [Full Text] [PDF]

				J. E. Chelly and B. Ben-David Do Continuous Femoral Nerve Blocks Affect the Hospital Length of Stay and Functional Outcome? Anesth. Analg., April 1, 2007; 104(4): 996 - 997. [Full Text] [PDF]

				F. V. Salinas Do Continuous Femoral Nerve Blocks Affect the Hospital Length of Stay and Functional Outcome? Anesth. Analg., April 1, 2007; 104(4): 997 - 998. [Full Text] [PDF]

				H. Kehlet Postoperative Analgesia and Hospital Stay: A Call for Better Study Design Anesth. Analg., January 1, 2007; 104(1): 212 - 212. [Full Text] [PDF]

				F. V. Salinas Postoperative Analgesia and Hospital Stay: A Call for Better Study Design Anesth. Analg., January 1, 2007; 104(1): 212 - 213. [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999