ICJR Interviews: Comparing Pain Control Techniques in TKA Patients

    With no block room available, anesthetists at Concordia Hospital in Winnipeg, Manitoba, Canada, were placing continuous femoral nerve blocks in the operating room right before the start of total knee arthroplasty (TKA) procedures.

    Not only did this increase procedure time and disrupt the flow in the operating room, but it also raised clinical questions: Was there really a benefit to using continuous femoral nerve blocks to manage pain after TKA? Or were periarticular injections, which were part of the flow of the procedure, just as effective?

    To settle the issue, the anesthesiology and orthopaedic departments came together for a prospective, double-blinded, randomized controlled trial comparing the 2 techniques in 72 patients under age 70 who were undergoing TKA for knee osteoarthritis.

    As part of a multimodal pain management protocol, all patients received the same preoperative, intraoperative, and postoperative analgesia that included controlled-release hydromorphone, celecoxib, acetaminophen, spinal anesthesia, and intravenous patient-controlled analgesia.

    The researchers assessed pain at rest and with activity twice a day on the first 2 days after surgery. They also evaluated range of motion, walking tolerance, use of opioids, length of stay, and patient satisfaction.

    They found no differences between groups in pain control or other measures assessed, and as a result, have discontinued routine use of continuous femoral nerve blocks in TKA patients.

    Click the image above to hear Thomas R. Turgeon, MD, FRCSC, discuss the study, “Femoral Nerve Block is Not Superior to Periarticular Injection for Primary Total Knee Analgesia” (Paper 662), which was presented at the 2016 Annual Meeting of the American Academy of Orthopaedic Surgeons in Orlando.

    Producer: Henrik B. Pedersen, MD; Director: Michael Bugera; Post Production: Charles J. Maynard