A Comparison of Continuous Femoral Nerve Block (CFNB) and Continuous Epidural Infusion (CEI) in Postoperative Analgesia and Knee Rehabilitation after Total Knee Arthroplasty (TKA)
Petchara Sundarathiti MD*, Narut Ruananukul MD*, Thanapot Channum MD**, Chusak Kitkunasathean MD**, Aunthika Mantay MD*, Jadesadha Thammasakulsiri MD*, Wanida Sodsee RN*
Affiliation : * Department of Anesthesiology, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand ** Department of Orthopaedics, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand
Background : Postoperative epidural analgesia (EA) and femoral nerve block (FNB) provided effective pain
relief. However, EA has common side effects such as nausea, vomiting, pruritus, dizziness, and hypotension.
Some investigations found that those side effects were less in FNB than in EA. However, the analgesic equivalent
of both techniques have not been confirmed.
Objective : The authors compared continuous epidural infusion (CEI) with continuous femoral nerve block
(CFNB) regarding the postoperative analgesic efficacy, side effects, postoperative knee rehabilitation, and
hospital length of stay (LOS).
Material and Method: In this prospective, randomized controlled study, 61 ASA physical status I-III patients
scheduled for elective unilateral total knee arthroplasty (TKA) under spinal anesthesia (SA) participated.
The patients were allocated into two groups. In the ward, patients in Group I (CEI) were maintained by
continuous infusion of 0.125% levobupivacaine with morphine 0.0125 mg/ml (4ml/hr), Group II (CFNB) were
maintained by 0.125% levobupivacaine (8 ml/hr).
Results : Patients in the CFNB group, the VAS scores at PO6-12 hr and tramadol IV requirement were
significantly greater than the CEI group (VAS: PO6 hr p-value = 0.001, PO12 hr p-value = 0.004). Patients in
the CEI group experienced dizziness, pruritus, and PONV more than the CFNB group significantly. Patient
’satisfaction was greater with the CFNB group although postoperative knee rehabilitation and the hospital
LOS were not different.
Conclusion : CFNB represents the optimal analgesia with fewer side effects and greater patient, satisfaction.
The rehabilitation indices and duration of hospital stay are comparable in both groups.
Keywords : Continuous femoral nerve block, Postoperative analgesia, Total knee arthroplasty, Levobupivacaine
