Department of Orthopaedic Surgery, Lahey Clinic Medical Center, 41 Mall Road, Burlington, MA 01805, USA.
Clin Orthop Relat Res. 2010 Jan;468(1):135-40. doi: 10.1007/s11999-009-1025-1. Epub 2009 Aug 13.
Preemptive and multimodal pain control protocols have been introduced to enhance rehabilitation after total knee arthroplasty (TKA). We determined the complication rate associated with preoperative femoral nerve block (FNB) for TKA. Among 1018 TKA operations, we performed 709 FNBs using a single-injection technique into the femoral nerve sheath and confirming position with nerve stimulation before induction. After TKA, weightbearing as tolerated was initiated using a walker or crutches on postoperative Day 1. Twelve patients (1.6%) treated with FNB sustained falls, three (0.4%) of whom underwent reoperations. Five patients had postoperative femoral neuritis, which may have been secondary to the block. One patient had new onset of atrial fibrillation after FNB, and the TKA was postponed. Femoral nerve block before TKA is not a harmless intervention. We recommend postoperative protocols be modified for patients who have FNB to account for decreased quadriceps function in the early postoperative period, which can lead to falls.
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
译文：
为了促进全膝关节置换术（TKA）后的康复，已经引入了预防性和多模式疼痛控制方案。我们确定了与 TKA 术前股神经阻滞（FNB）相关的并发症发生率。在 1018 例 TKA 手术中，我们使用单次注射技术将 709 例 FNB 注入股神经鞘中，并在诱导前使用神经刺激确认位置。TKA 后，患者在术后第 1 天使用助行器或拐杖开始耐受负重。12 例接受 FNB 治疗的患者发生跌倒，其中 3 例（0.4%）需要再次手术。5 例患者出现术后股神经炎，可能与阻滞有关。1 例患者在 FNB 后出现新发心房颤动，TKA 被推迟。TKA 前的股神经阻滞并非无害的干预措施。我们建议修改术后方案，以便对接受 FNB 的患者进行管理，以考虑到术后早期股四头肌功能下降，这可能导致跌倒。
证据水平：III 级，治疗性研究。欲了解完整的证据水平描述，请参见作者指南。
