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ANALGESIA

Health-Related Quality of Life After Tricompartment Knee Arthroplasty With and Without an Extended-Duration Continuous Femoral Nerve Block: A Prospective, 1-Year Follow-Up of a Randomized, Triple-Masked, Placebo-Controlled Study

Brian M. Ilfeld, MD, MS^*, R. Scott Meyer, MD, Linda T. Le, MD, Edward R. Mariano, MD^*, Brian A. Williams, MD, MBA, Krista Vandenborne, PhD, PT^||, Pamela W. Duncan, PhD, PT^¶, Daniel I. Sessler, MD^#, F. Kayser Enneking, MD, Jonathan J. Shuster, PhD^**, Rosalita C. Maldonado, BS^*, and Peter F. Gearen, MD

From the Departments of *Anesthesiology, Orthopaedic Surgery, University of California San Diego, San Diego, California; Department of Anesthesiology, The University of Florida, Gainesville, Florida; Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania; ||Department of Physical Therapy, the University of Florida, Gainesville, Florida; ¶Division of Doctor of Physical Therapy, Department of Community and Family Medicine, Duke Center for Clinical Health Policy Research, and Duke Center on Aging, Duke University, Durham, North Carolina; #Department of Outcomes Research, and the Cleveland Clinic, Cleveland, Ohio; Departments of **Epidemiology and Health Policy Research, and Orthopaedics and Rehabilitation, The University of Florida, Gainesville, Florida.

Address correspondence and reprint requests to Brian M. Ilfeld, MD, MS, Department of Anesthesiology, UCSD Center for Pain Medicine, 9300 Campus Point Dr.–MC 7651, LA Jolla, CA 92037-7651. Address e-mail to bilfeld{at}ucsd.edu or www.or.org.

Abstract

BACKGROUND: We previously provided evidence that extending an overnight continuous femoral nerve block to 4 days after tricompartment knee arthroplasty (TKA) provides clear benefits during the perineural infusion in the immediate postoperative period. However, it remains unknown if the extended infusion improves subsequent health-related quality of life between 7 days and 12 mo.

METHODS: Patients undergoing TKA received a femoral perineural infusion of ropivacaine 0.2% from surgery until the following morning, at which time patients were randomized to either continue perineural ropivacaine (n = 25) or normal saline (n = 25) in a double-masked fashion. Patients were discharged with their catheter and a portable infusion pump, and catheters were removed on postoperative day 4. Health-related quality of life was measured using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index preoperatively and then at 7 days, as well as 1, 2, 3, 6, and 12 mo after surgery. The WOMAC evaluates three dimensions of health-related quality of life: pain, stiffness, and physical functional disability. For inclusion in the analysis, we required a minimum of 4 of the 6 time points, including day 7 and at least 2 of mo 3, 6, and 12.

RESULTS: The two treatment groups had similar WOMAC scores for the mean area under the curve calculations (point estimate for the difference in mean area under the curve for the two groups [overnight infusion group–extended infusion group] = 1.2, 95% confidence interval: –5.6 to +8.0; P = 0.72) and at all individual time points (P > 0.05).

CONCLUSIONS: We found no evidence that extending an overnight continuous femoral nerve block to 4 days improves (or worsens) subsequent health-related quality of life between 7 days and 12 mo after TKA. (ClinicalTrials.gov number, NCT00135889.)

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				B. M. Ilfeld, S. T. Ball, P. F. Gearen, E. R. Mariano, L. T. Le, K. Vandenborne, P. W. Duncan, D. I. Sessler, F. K. Enneking, J. J. Shuster, et al. Health-Related Quality of Life After Hip Arthroplasty With and Without an Extended-Duration Continuous Posterior Lumbar Plexus Nerve Block: A Prospective, 1-Year Follow-Up of a Randomized, Triple-Masked, Placebo-Controlled Study Anesth. Analg., August 1, 2009; 109(2): 586 - 591. [Abstract] [Full Text] [PDF]