Postoperative analgesic efficacy of fascia iliaca block versus periarticular injection for total knee arthroplasty

• Published in: Journal of clinical anesthesia 2016-12, Vol.35, p.404-410
• Main Authors: Bali, Cagla, MD, Ozmete, Ozlem, MD, Eker, H. Evren, MD, Hersekli, Murat A., MD, Aribogan, Anis, MD
• Format: Article
• Language: English
• Subjects: Aged; Analgesics; Anesthesia; Anesthesia & Perioperative Care; Anesthetics, Local - administration & dosage; Arthroplasty, Replacement, Knee; Bupivacaine - administration & dosage; Fascia - drug effects; Fascia iliaca block; Humans; Injections, Intra-Articular; Joint surgery; Lidocaine - administration & dosage; Middle Aged; Narcotics; Nerve Block - methods; Nonsteroidal anti-inflammatory drugs; Pain; Pain Medicine; Pain, Postoperative - drug therapy; Patients; Periarticular drug injection; Prospective Studies; Skin; Surgeons; Surgery; Total knee arthroplasty; Treatment Outcome; Ultrasonic imaging
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2016.08.030

Abstract Study objective This study evaluated the postoperative analgesic efficacies of fascia iliaca block and periarticular drug injection techniques after TKA (total knee arthroplasty) surgeries. Design Prospective, randomized clinical trial. Setting University Teaching and Research Center. Patients Seventy-one American Society of Anesthesiologists (ASA) I-III patients between 48 and 70 years of age who underwent total knee arthroplasty were randomized. Interventions Tenoxicam (20 mg) was administered intramuscularly to both groups of patients 30 minutes before surgery. Patients were randomized into two groups to receive fascia iliaca block before the induction of anesthesia (Group FI) or periarticular drug injection during the surgery (Group PI). All surgeries were performed under general anesthesia using standard techniques. Postoperative analgesia was provided with patient-controlled intravenous morphine. Measurements Total morphine consumption was the primary outcome measure and was recorded postoperatively at 1, 2, 6, 12 and 24 hours. Pain levels at rest and on movement (knee flexion) were evaluated using the Visual Analogue Scale (VAS) and recorded at the same time points. Patients' demographics, rescue analgesic demands, side effects, hemodynamics, and satisfaction scores were also recorded. Main results The groups had similar VAS scores both at rest and on movement (P > .05). However, the amount of cumulative morphine and use at each follow-up period was higher in Group PI ( P < .0001). The groups did not differ significantly in rescue analgesic use or side effects, such as nausea/vomiting, hemodynamic variables, and patient satisfaction scores (P > .05). Conclusions Fascia iliaca block may be used as an alternative method to periarticular injection, and it effectively reduces the amount of morphine used to relieve post-TKA pain.