School of Nursing and Midwifery, Murdoch University, Education Drive, Mandurah 6210, Western Australia.
J Orthop Surg Res. 2011 Feb 7;6:7. doi: 10.1186/1749-799X-6-7.
Effective pain management following total knee arthroplasty (TKA) is fundamental in achieving positive rehabilitation outcomes. The purpose of our study was to investigate post operative pain management in relation to short term functional mobility in an intervention group receiving concomitant use of an IV narcotic PCA and a continuous infusion of local anaesthetic via a femoral nerve catheter (CFNC), compared to a group receiving narcotic PCA alone. This was a preliminary study conducted to establish an appropriate design for a larger investigative study.
A prospective design was used to measure the effect of a CFNC on post operative pain management and functional mobility prior to hospital discharge. The amount of fentanyl used, pain and nausea scores, timed up and go (TUG) tests and active range of knee movement (AROM) were used to compare a CFNC and supplemental narcotic patient controlled analgesia (PCA) group (n = 27) with a PCA only group (n = 25).
The CFNC group used significantly less fentanyl than the PCA only group (p < .001) but there was no significant difference in TUG times between the two groups. There was however a significantly lower AROM reported for both extension (p < .04) and flexion (p < .006,) in the FNC group. Women had significantly slower TUG times (p < .005,) and there were moderate to strong positive correlations between post operative TUG times and the preoperative TUG time (r(s) = .505 p < .001), the time since oral analgesia (r(s) = .529 p < .014), and pain scores (r(s) = .328, p = .034)
In this small preliminary study improved TUG performance at Day 4 post op was not influenced by the use of a CFNC but was positively correlated with male gender, preoperative performance, time elapsed since last oral analgesia and pain score. However AROM was decreased in the CFNC group suggesting further research on the relationship between CFNCs, local anaesthetic concentration and quadriceps strength should be incorporated in the follow up study's design.
全膝关节置换术后（TKA）有效的疼痛管理是实现积极康复效果的基础。我们研究的目的是调查接受静脉内阿片类药物 PCA 联合股神经导管（CFNC）持续输注局部麻醉的干预组与仅接受阿片类药物 PCA 的组之间术后疼痛管理与短期功能移动性的关系。这是一项初步研究，旨在为更大规模的研究设计建立合适的方案。
前瞻性设计用于测量 CFNC 对出院前术后疼痛管理和功能移动性的影响。使用芬太尼用量、疼痛和恶心评分、计时起立和行走（TUG）测试以及主动膝关节活动范围（AROM）来比较 CFNC 和补充阿片类药物患者自控镇痛（PCA）组（n = 27）与仅 PCA 组（n = 25）。
CFNC 组使用的芬太尼明显少于仅 PCA 组（p <.001），但两组的 TUG 时间无显著差异。然而，CFNC 组的 AROM 报告在伸展（p <.04）和屈曲（p <.006）方面均显著降低。女性的 TUG 时间明显较慢（p <.005），术后 TUG 时间与术前 TUG 时间（r(s) =.505 p <.001）、口服镇痛药后时间（r(s) =.529 p <.014）和疼痛评分（r(s) =.328，p =.034）之间存在中度至强正相关。
在这项小型初步研究中，术后第 4 天 TUG 表现的改善不受 CFNC 使用的影响，但与男性性别、术前表现、上次口服镇痛药后时间和疼痛评分呈正相关。然而，CFNC 组的 AROM 降低，表明在后续研究设计中应纳入 CFNC、局部麻醉浓度和股四头肌力量之间关系的进一步研究。
