Pain Clinical Trial
Official title:
Comparison of Continuous Femoral Nerve Block Using Ultrasound Versus Ultrasound and Nerve Stimulation Using Stimulating Catheter in Patients Undergoing Total Knee Arthroplasty: A Prospective Randomized Controlled Trial
The purpose of this study is to determine which technique for catheter placement in continuous femoral nerve block (FNB) is most successful - guidance with (1) ultrasound or (2) nerve stimulation and ultrasound. Sensory and motor assessment scores will be obtained post-FNB. Patient controlled analgesia and opiate consumption is also recorded along with pain scores for the first 48 hour post-FNB.
Continuous femoral nerve block (cFNB) is a widely used regional anesthetic technique for
many lower limb operations, such as total knee arthroplasty (TKA), anterior cruciate
ligament repair, tibial osteotomy and patellar surgery. It provides superior pain relief,
faster ambulation, shorter hospital stays and less risk of side effects in comparison to
patient controlled analgesia (PCA), local anesthetic wound infiltration, or single shot
femoral nerve block (FNB).
Stimulating catheters were introduced in 1999 to provide an objective end point to guide
continuous nerve block catheter position by maintaining the desired evoked muscle response
with nerve stimulation (NS). The main advantages of stimulating catheters are faster onset
of sensory and motor block and reduction of local anesthetic drugs consumption. In recent
years the precise insertion of continuous catheters has improved especially with the
introduction of ultrasound (US)-guided imaging to regional anesthesia practice and advances
in scanning techniques. That led to a call to reduce cost by switching to non-stimulating
catheters. However, most studies comparing both catheters lacked anesthetic technique
standardization and adequate sample size.
In this prospective randomized controlled trial, we compared postoperative analgesic
efficacy and opioids consumption in patients having cFNB insertion using US alone and that
of US combined with NS.
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