Continuous Femoral Catheter for Postoperative Analgesia After Total Knee Arthroplasty
Giovanni Cappiello, Lawrence Camarda, Giuseppe Pulito, Andrea Tarantino, Daniela Di Martino, Valentina Russi, Leonardo Stramazzo, Clara Ragusa, Gianmarco Guarino, Umberto Ripani.
Introduction: Postoperative pain management in the total knee replacement (TKR) represent a fundamental step for a positive outcome, allowing rapid mobilization, already on the first day. Further, continuous peripheral nerve block techniques have been reported to allow effective and safe control of acute postoperative pain, ensuring the implementation and completion of an accurate and intensive joint rehabilitation program. Aim: The aim of this study was to assess early mobility and compliance of patients that underwent TKR surgery using the femoral block. Methods: For the study, all patients that underwent TKR from 2015 to 2018 with ASA score between II-III was evaluated. Patients underwent vital parameters monitoring and were treated initially with midazolam (0.05mg / kg) e.v. combined sciatic block + femoral perineural catheter positioning using a peripheral nerve stimulation-assisted technique. Results: Intraoperatively, satisfactory analgesia was guaranteed in all patients, associated with a complete muscle relaxation of the affected limb. High patient compliance, associated with good control of acute postoperative pain was obtained in the first 24 hours after surgery (VAS 0- 1). The ROM outcomes were good in all rehabilitation stages, managing to reach 90 degrees bending on the seventh day with an average KSS score of 88-90. Patient satisfaction and impact on quality of life were assessed with the SF-36 showing average scores of 78. Conclusion: Continuous femoral nerve blocking ensures good postoperative analgesia in TKR allowing an early joint mobilization, a rapid functional recovery of the knee and increasing patient compliance during the post-operative rehabilitation program.
Key words: Continuous femoral block, Knee Arthroplasty, Anesthesia, Loco-Regional Treatment, Outcomes.