A comparative study between continuous epidural analgesia, ultrasound guided continuous femoral nerve block (CFNB), and ultrasound guided continuous adductor canal block (ACB) for post-operative pain management after total knee replacement (TKR)
Abstract Background Total knee replacement (TKR) is considered a prevailing cause of severe postoperative pain and discomfort among orthopedic surgeries, limiting postoperative ambulation that is important for regaining joint function. Despite being the gold standard, epidural analgesia can be accom...
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| Format: | Article |
| Language: | English |
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SpringerOpen
2023-03-01
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| Series: | Ain Shams Journal of Anesthesiology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s42077-023-00311-z |
| _version_ | 1797853990877134848 |
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| author | Remon Nadhy Nassif Kalad Hoda Omar Mahmoud Ali Wael Reda Hussein Thabet Abdelrahman Mabrouk Abdelghaffar Elsotouhy Amr Gaber Sayed Sharaf |
| author_facet | Remon Nadhy Nassif Kalad Hoda Omar Mahmoud Ali Wael Reda Hussein Thabet Abdelrahman Mabrouk Abdelghaffar Elsotouhy Amr Gaber Sayed Sharaf |
| author_sort | Remon Nadhy Nassif Kalad |
| collection | DOAJ |
| description | Abstract Background Total knee replacement (TKR) is considered a prevailing cause of severe postoperative pain and discomfort among orthopedic surgeries, limiting postoperative ambulation that is important for regaining joint function. Despite being the gold standard, epidural analgesia can be accompanied by diverse complications delaying postoperative ambulation and discharge from hospital. Continuous femoral nerve block (CFNB) and continuous adductor canal block (ACB) are reliable and efficacious regional anaesthesia techniques allowing better control of postoperative pain. This study purposed to compare epidural analgesia, continuous femoral nerve block & continuous adductor canal block regarding postoperative analgesia & incidence of postoperative complications. The aim of this study is to estimate the efficacy of epidural analgesia, continuous femoral nerve block & continuous adductor canal block regarding postoperative pain control following total knee replacement and the rate of incidence of associated postoperative complications. This is a prospective randomized controlled study where sixty patients were randomized into three equal groups, patients in group A received epidural analgesia, patients in group B received continuous femoral nerve block while patients in group C received continuous adductor canal block with postoperative continuous infusion of 0.125% bupivacaine with fentanyl 2µg/ml in the three groups at a rate of 5 ml/hr. VAS score was assessed for 48 hours post-operatively and complications were recorded. Results Epidural analgesia was superior to CFNB and ACB regarding postoperative pain control using visual analogue scale and postoperative pain control. CFNB and ACB are superior to epidural analgesia regarding postoperative ambulation and postoperative complications. Conclusions Continuous epidural analgesia provides superior analgesia following total knee replacement than femoral nerve block and adductor canal block, with relatively more adverse effects like pruritus, post operative nausea, and vomiting (PONV). Both CFNB and ADB are good alternatives with fewer systemic side effects. Trial registration ClinicalTrials.gov Identifier: NCT 05249478. |
| first_indexed | 2024-04-09T19:59:40Z |
| format | Article |
| id | doaj.art-7462573c05a945d08c9b2d5979d5c296 |
| institution | Directory Open Access Journal |
| issn | 2090-925X |
| language | English |
| last_indexed | 2024-04-09T19:59:40Z |
| publishDate | 2023-03-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Ain Shams Journal of Anesthesiology |
| spelling | doaj.art-7462573c05a945d08c9b2d5979d5c2962023-04-03T05:17:16ZengSpringerOpenAin Shams Journal of Anesthesiology2090-925X2023-03-011511910.1186/s42077-023-00311-zA comparative study between continuous epidural analgesia, ultrasound guided continuous femoral nerve block (CFNB), and ultrasound guided continuous adductor canal block (ACB) for post-operative pain management after total knee replacement (TKR)Remon Nadhy Nassif Kalad0Hoda Omar Mahmoud Ali1Wael Reda Hussein Thabet2Abdelrahman Mabrouk Abdelghaffar Elsotouhy3Amr Gaber Sayed Sharaf4Department of Anesthesiology, Intensive care and Pain Management, Faculty of Medicine, Ain-Shams UniversityDepartment of Anesthesiology, Intensive care and Pain Management, Faculty of Medicine, Ain-Shams UniversityDepartment of Anesthesiology, Intensive care and Pain Management, Faculty of Medicine, Ain-Shams UniversityDepartment of Anesthesiology, Intensive care and Pain Management, Faculty of Medicine, Ain-Shams UniversityDepartment of Anesthesiology, Intensive care and Pain Management, Faculty of Medicine, Ain-Shams UniversityAbstract Background Total knee replacement (TKR) is considered a prevailing cause of severe postoperative pain and discomfort among orthopedic surgeries, limiting postoperative ambulation that is important for regaining joint function. Despite being the gold standard, epidural analgesia can be accompanied by diverse complications delaying postoperative ambulation and discharge from hospital. Continuous femoral nerve block (CFNB) and continuous adductor canal block (ACB) are reliable and efficacious regional anaesthesia techniques allowing better control of postoperative pain. This study purposed to compare epidural analgesia, continuous femoral nerve block & continuous adductor canal block regarding postoperative analgesia & incidence of postoperative complications. The aim of this study is to estimate the efficacy of epidural analgesia, continuous femoral nerve block & continuous adductor canal block regarding postoperative pain control following total knee replacement and the rate of incidence of associated postoperative complications. This is a prospective randomized controlled study where sixty patients were randomized into three equal groups, patients in group A received epidural analgesia, patients in group B received continuous femoral nerve block while patients in group C received continuous adductor canal block with postoperative continuous infusion of 0.125% bupivacaine with fentanyl 2µg/ml in the three groups at a rate of 5 ml/hr. VAS score was assessed for 48 hours post-operatively and complications were recorded. Results Epidural analgesia was superior to CFNB and ACB regarding postoperative pain control using visual analogue scale and postoperative pain control. CFNB and ACB are superior to epidural analgesia regarding postoperative ambulation and postoperative complications. Conclusions Continuous epidural analgesia provides superior analgesia following total knee replacement than femoral nerve block and adductor canal block, with relatively more adverse effects like pruritus, post operative nausea, and vomiting (PONV). Both CFNB and ADB are good alternatives with fewer systemic side effects. Trial registration ClinicalTrials.gov Identifier: NCT 05249478.https://doi.org/10.1186/s42077-023-00311-zEpidural analgesiaFemoral nerve blockAdductor canal blockTotal knee replacement |
| spellingShingle | Remon Nadhy Nassif Kalad Hoda Omar Mahmoud Ali Wael Reda Hussein Thabet Abdelrahman Mabrouk Abdelghaffar Elsotouhy Amr Gaber Sayed Sharaf A comparative study between continuous epidural analgesia, ultrasound guided continuous femoral nerve block (CFNB), and ultrasound guided continuous adductor canal block (ACB) for post-operative pain management after total knee replacement (TKR) Ain Shams Journal of Anesthesiology Epidural analgesia Femoral nerve block Adductor canal block Total knee replacement |
| title | A comparative study between continuous epidural analgesia, ultrasound guided continuous femoral nerve block (CFNB), and ultrasound guided continuous adductor canal block (ACB) for post-operative pain management after total knee replacement (TKR) |
| title_full | A comparative study between continuous epidural analgesia, ultrasound guided continuous femoral nerve block (CFNB), and ultrasound guided continuous adductor canal block (ACB) for post-operative pain management after total knee replacement (TKR) |
| title_fullStr | A comparative study between continuous epidural analgesia, ultrasound guided continuous femoral nerve block (CFNB), and ultrasound guided continuous adductor canal block (ACB) for post-operative pain management after total knee replacement (TKR) |
| title_full_unstemmed | A comparative study between continuous epidural analgesia, ultrasound guided continuous femoral nerve block (CFNB), and ultrasound guided continuous adductor canal block (ACB) for post-operative pain management after total knee replacement (TKR) |
| title_short | A comparative study between continuous epidural analgesia, ultrasound guided continuous femoral nerve block (CFNB), and ultrasound guided continuous adductor canal block (ACB) for post-operative pain management after total knee replacement (TKR) |
| title_sort | comparative study between continuous epidural analgesia ultrasound guided continuous femoral nerve block cfnb and ultrasound guided continuous adductor canal block acb for post operative pain management after total knee replacement tkr |
| topic | Epidural analgesia Femoral nerve block Adductor canal block Total knee replacement |
| url | https://doi.org/10.1186/s42077-023-00311-z |
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