Comparison of Intra-articular Analgesia and Femoral Nerve Block for Postoperative Pain Relief in Unilateral Total Knee Arthroplasty: A Randomized Clinical Study.

BACKGROUND AND AIMS

Femoral nerve block (FNB) and intra-articular analgesia (IAA) are used for postoperative analgesia after total knee arthroplasty (TKA).

AIMS AND OBJECTIVES

We aimed to determine the better technique among the two, with regard to duration and quality of postoperative analgesia along with 24-h rescue analgesic consumption. The functional recovery in the early postoperative period was also assessed.

SETTINGS AND DESIGN

This was a prospective double-blind study comprising 40 American Society of Anesthesiologists I-III patients undergoing elective TKA who were randomly assigned to two groups ( = 20).

METHODOLOGY

In Group A, 20 mL ropivacaine 0.5%, containing dexmedetomidine (1 μg.kg ), was given by FNB, and in Group B, intra-articular administration of the same drug was done. Analgesic effect was evaluated by measuring the Visual Analog Scale (VAS) and duration of analgesia. Quadriceps muscle strength was noted.

STATISTICAL ANALYSIS

Observation data obtained were reported as mean value and analyzed using Student's -test or Wilcoxon/Mann-Whitney rank test.

RESULTS

The mean VAS on passive movement at the 2, 6, and 16 h postoperatively was 1.75 ± 0.44, 2.90 ± 0.72, and 2.75 ± 0.44 in Group A as compared to 2.25 ± 0.72, 4.30 ± 2.05, and 2.20 ± 0.77 in Group B ( = 0.026, 0.043, and 0.014, respectively). In Group A, the first request for analgesic (rescue analgesic) was at 637 ± 119 min and the total consumption of tramadol was 50.00 mg. In Group B, the first request for analgesic was at 404.44 ± 136 min, with a total dose of 63.89 mg. The Pvalue for the time of rescue analgesic was <0.001, while for total drug consumption, it was 0.018.

CONCLUSION

We concluded that the duration and quality of analgesia (VAS) were significantly superior and rescue analgesic requirement less in patients who received FNB as compared to IAA.