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ANALGESIA

Continuous Femoral Nerve Analgesia After Unilateral Total Knee Arthroplasty: Stimulating Versus Nonstimulating Catheters

Salim M. Hayek, MD, PhD^*, R. Michael Ritchey, MD^*||, Daniel Sessler, MD, Robert Helfand, MD^||, Samuel Samuel, MD^*, Meng Xu, MS^¶, Michael Beven, BA^*, Demetrios Bourdakos, MD^||, Wael Barsoum, MD^#, and Peter Brooks, MD^#

From the Departments of *Pain Management, Outcomes Research, ||General Anesthesiology, ¶Quantitative Health Sciences, and #Orthopaedic Surgery, The Cleveland Clinic, Cleveland, Ohio; Outcomes Research Institute; and Department of Anesthesiology, University of Louisville, Louisville, Kentucky.

Address correspondence and reprint requests to Salim Michel Hayek, MD, PhD, Division of Pain Medicine, Department of Anesthesiology, University Hospitals Case Medical Center, 11100 Euclid Ave., Cleveland, OH 44106. Address e-mail to salim.hayek{at}uhhospitals.org

Abstract

BACKGROUND: Continuous femoral analgesia provides extended pain relief and improved functional recovery for total knee arthroplasty (TKA). Stimulating catheters may allow more accurate placement of catheters.

METHODS: We performed a randomized prospective study to investigate the use of stimulating catheters versus nonstimulating catheters in 41 patients undergoing TKA. All patients received IV patient-controlled anesthesia for supplementary pain relief. The principal aim of the trial was to examine whether a stimulating catheter allowed the use of lesser amounts of local anesthetics than a nonstimulating catheter. The additional variables we examined included postoperative pain scores, opioid use, side effects, and acute functional orthopedic outcomes.

RESULTS: Analgesia was satisfactory in both groups, but there were no statistically significant differences in the amount of ropivacaine administered; the median amount of ropivacaine given to patients in the stimulating catheter group was 8.2 mL/h vs 8.8 mL/h for patients with nonstimulating catheters, P = 0.26 (median difference –0.6; 95% confidence interval, –2.3 to 0.6). No significant differences between the treatment groups were noted for the amount of fentanyl dispensed by the IV patient-controlled anesthesia, numeric pain rating scale scores, acute functional orthopedic outcomes, side effects, or amounts of oral opioids consumed.

CONCLUSION: The use of stimulating catheters in continuous femoral nerve blocks for TKA does not offer significant benefits over traditional nonstimulating catheters.

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