RESEARCH ARTICLE


Effect of Pre-Incisional Continuous Regional Block on Early and Late Postoperative Conditions in Tibial Osteotomy and Total Knee Arthroplasty



C Motamed*, X Combes, S.-K Ndoko, G Dhonneur
Service d'Anesthésie - Réanimation, Hôpital Henri Mondor, AP-HP et Université Paris XII, Créteil, France


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Creative Commons License
© Motamed et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Service d'Anesthésie - Réanimation, Institut Gustave Roussy, 39 Rue Camille Desmoulins, 94805 Villejuif, Cedex, France; Tel: 33-1-42114436; E-mail: motamed@igr.fr


Abstract

Background:

Postoperative regional anesthesia hastens recovery and reduces the length of hospital stay of orthopedic surgical patients. This study was designed to assess the impact of pre-incisional continuous femoral block on postoperative conditions (POC) of tibial osteotomy and total knee arthroplasty patients.

Methods:

After insertion of a femoral catheter under peripheral nerve stimulation control, 111 patients scheduled for total knee arthroplasty or tibial osteotomy were randomized to receive either pre-incisionnal (treatment) or postoperative (control) continuous femoral block. Anesthesia and postoperative management was standardized. An assessor blinded to the randomization process recorded early and late postoperative conditions (POC) which included pain scores, opioid demands, length of stay in Postoperative care unit and patients’ satisfaction.

Results:

Eleven patients were excluded from the final analysis because of catheter disconnection or malfunction. Thus 100 patients (50 in each group) were analyzed for POC. Treatment failed to influence patients overall satisfaction but significantly improved early POC. Subgroup analysis demonstrated that late POC were significantly improved in tibial osteotomy as compared to total knee arthroplasty patients. No complication occurred during the study period.

Conclusion:

Continuous femoral nerve block before surgery significantly improved early postoperative conditions in both surgery while late postoperative conditions were improved only in tibial osteotomy.

Keywords: Postoperative pain, total knee arthroplasty, tibial osteotomy, femoral block, bupivacaine.