Epidural analgesia compared with femoral nerve block for postoperative pain therapy after total knee arthroplasty – a matched pair analysis

Johannes Jauch, Thomas Schilling, Dominik Brammen, Uwe Ebmeyer, Siegfried Kropf, Thomas Hachenberg, Alf Kozian,

Alf Kozian, Epidural analgesia compared with femoral nerve block for postoperative pain therapy after total knee arthroplasty

Background: Combined epidural analgesia (EA) and patient controlled analgesia (PCA) for postoperative pain control after total knee arthroplasty (TKA) is well established. Previous studies demonstrated the effectiveness of femoral nerve block (FNB) in combination with PCA. This study compares clinical efficiency and adverse events of pain therapy of an established (EA+PCA) and a modified (FNB+PCA) protocol.

Methods: A retrospective, single-center cohort study analyzing TKA patients after subarachnoid anesthesia. Matched pair analysis was performed using filters for American Society of Anesthesiologists (ASA) classification, age, gender, height, weight, comorbidities and prior use of analgesics. Surgical technique and postoperative medication protocol were similar in both groups. Primary outcome was postoperative pain on movement assessed by a visual analog scale (VAS) and use of analgesics within 72 hours after surgery. Secondary, incidence of adverse events (postoperative nausea and vomiting, pruritus, urinary retention and hypotension) was examined.

Results: From a total of 846 patients, 104 matched pairs were built and analyzed within 72 hours after surgery. Mean VAS scores were similar in patients receiving EA+PCA (2.7 ± 1.1) or FNB+PCA (2.8 ± 1.2). Supplemental opioid administration was higher in EA+PCA patients. Hypotension was more frequent in EA+PCA as in FNB+PCA patients (36 % vs. 12 %). Combined adverse events were more frequent in EA+PCA as in FNB+PCA patients (75 % vs. 58 %).

Conclusions: Both FNB+PCA and EA+PCA results in equivalent degrees of analgesia after TKA. Converting an established mode of pain therapy to a modified protocol may decrease incidence of adverse events rather than improve quality of analgesia.

Key words: analgesia, epidural analgesia, femoral nerve block, postoperative pain, total knee arthroplasty

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