A dc, Original uYIUfiglufluu · e{aro{lnr:rit femoral nerve block sias o.b nJoirfrusi...
Transcript of A dc, Original uYIUfiglufluu · e{aro{lnr:rit femoral nerve block sias o.b nJoirfrusi...
e{aro{lnr:rit femoral nerve block sias o.b nJoirfrusi levobupivacaine
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Result of Femoral Nerve Block with o.|Vo Levobupivacaine to Reduced
Pain after Total Knee Replacement within z+ hrs
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A dc, a.,
uYIUfiglufluu Original article
Thanin Pinyopornpanit** M.D.
Sumana Watcharadirekrat* B.N.S.
* Nursing Department
** Department of anesthesiology
Sawanpracharak Hospital
Nakhon Sawan
Sawanpracharak Medical Journalda v d
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To study that femoral nerve block can reducing severity of pain in
patients who received total knee replacement and how.
Perioperative room Sawanpracharak Hospital.
A double blind, prospective randomized control trial.
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Abstract
Objective
Setting
Design
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tuoirornl:rir femoral neroe block deq o.r nJoir{uri levqbupivacainerfiooaornr:ilenrrd.rnr:ritffnrJ6auianirnrt,lu zl ieli.r
Result of Femoral Nerve Block with o.57o Levobupiyacaine to Reduced Pain
after Total Knee Replacement within zl hrs 37
Method
Results
Study in patients in patients who received total knee replacement in
Sawanpracharak Hospital between November 2008 to May 2009, there
were ASA physical status l-ll and spinal anesthesia was technique of
choice. 60 patients were divided to two groups; i.e. a spinal anesthesia
O.5% bupivacaine 3.0 cc addition with femoral nerve block O.5"h
levobupivacaine 20 cc amount 30 cases and a spinal anesthesia
O.5% bupivacaine 3.0 cc alone amount 30 cases. Demographic data,
VAS before and after spinal anesthesia at 8t', 12th,16h and 24h hr were
recorded, identified with mild pain = VAS 0-3, moderate pain = VAS
4-7, severe pain = VAS 8-10. The side effects, nausea vomiting and
hospital length of stay were also recorded. Significant of different
between two groups were using T-test and exact probability test.
Patients who received spinal anesthesia addition with femoral nerve
block were mean age 64.9 yrs (SD : 6.3), body weight 65.7 kg
(SD = 10.0), height 156.9 cm (SD = 6.2). The most of patients haci
ASA class ll (93.3%), 16.7y" were male and 83.3% were female, mean
the operation time 112 min (SD = 32.1), blood loss 101.7 ml (SD = 83.5).
ln spinal anesthesia addition with femoral nerve block group were
mean VAS before spinal anesthesia 7.1 (SD = 1.4) not significant
between spinal anesthesia alone group (p-value = 0.409), mean VAS
at 8h hr after spinal anesthesia in addition femoral nerve block group
was 2.1 (SD = 0.6), at 12'h hr 3.5 (SD = 1.8), at 16b hr 4.5 (SD = 2.0)
and pain scale significantly lower in spinal anesthesia alone group
(p_value < 0.00'l). Mean VAS at 24h hr after spinal anesthesia in spinal
anesthesia alone group was 4.4 (SD = 1.4), not significant between
groups (p_value < 0.147). Mean first time to received pehidine significantly
longer 16.4 hr.(SD = 1.0, p-value < 0.001), mean total dose of pethidine
in 24 hrs significantly lesser 29.2 mg (SD = 4.8, p-value < 0.001) and
number of patients no nausea and vomiting significantly lower (56.7"/",
p-value < 0.001) in addition femoral nerve block group versus spinal
anesthesia alone group. No significant difference in nausea vomiting
and hospital length of stay.
E!
I
Conclusion
Key words
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n21 ril o L1j:UU [n fl U n1Tfl Ft U'l{',] t?\ U{ nT{ tFt U?v oe , i ols-nnnrrlfiurriariiatmaan 24 drlru.,:(") fl't:av , J'triur Fia rfi ai,6t1 il1Tn n?L nNa1n1:rhorlfifi il:rAAdIAYdAdU61110'R1y\lFtn?1(''"'' LLFIIJ?lO[6lEl FtO tTlilAn:1
A X ett A \ \yy An1:mnlfl a L[aur,Jl]? rlrnaau 114??1 Lnuafl rua{{
Xdaaa41fl block motor u1u?u iln1:Flftl*''l?fl 3 in 1
Obct< 6arir femoral nerve blocX irruniu lumbar
plexus block tLdv sciatic block6l1il1:n:c.1'!, lfgd d
L?nLAOn?1n1:Yl'l femoral nerve block tflfl.,]t d 5lI O o
a u1{ tFl El? ttFr ttt? n1 [u nlTnlu1iln?1 yrufl't?c.Y t t A.Y t r
ttflTndauil1nn'j1 [acFirlfiqirufltn'jrtl+ro d X va e v eaLunlTFlnl*lufi A{ lfi n1:Tu{U n?1}J:dn
tu e d'drJ.r u:n tri 1^r u fr rh nyY{ a a.: n ei ru fi ar nr:{q
,JEil?OtUA.,lA1nqnfiZA{ spinal anesthesia
fl,-:n,:ad durnr a-r o'i'rh,:'Lufrrh und:JdtfiIUIUq
-.A -)ilm I auun 1 il.n.-ru.u. 2554
irn'r:rir femoral nerve block fiarnr:rlrrt
riafln'ir rfiatarnaT trdlfi block femoralt,adt
nerve uuLl:velst?n1n1:aanql]f,u1un?1@ \e Avq lYv
a'.: tn ntdar n:vEjv L? n1 n r.tllr a Ln :u peth idi nea,,
ni.,:u:novulun'j1 Ltnu?lu1n?a{ pethidine
{i frrh alfiiutu 24 d"ilsJ{asfia u n'jr frrJr un{ru
dtfiiunr::v$u nmr.rifi nfirs spinal anesthesiad r d u 5l9/ v 9/4
tfr g.:a Ei'rt ud Elr fl a{n1T[x n1T:vnu n?1il:6lnA &r- v\ Y 4-,-fi z+ t'rh.,: rirhavLraa.:nrirufr arnl:ilxFl
,tqvrr@a4-- -JLrj oir.,:nu Lua{a'1fl n1:fi il nqno'fl a{ u'lt1Yl
block femoral nerve rrnr{rJrulfiiu?J1 pehidine
rfia:s$url2n(15)) tY d --'Lunriila1fl'l:nau[6{alLaguilutJ'Ifl q
drdAspinal anesthesia LYIU{Afl1{LAU') tUA{A1na t, , $tr -- re jfrrlrunduiild:u pethidine rl3rurrufrsq
il1nn'i1(16) drviuarnr:6'u kirrnneir.:riuJ qv a c
[Ua.]a1nn1TLl{ pethidine ttt.:maantaann,l
1,{u 01 n1:Fiuria a n'ir ud a nli uu rfi a u fiu nr:"lfr)d,
morphine fit rfl un-r:'Lfrurmr.: central opiod(17)
Result of Femoral Nerve Block with 0.5% LevobuPivacaine to Reduced Pain
after Total Knee Replatement within 24 lus
I
d:tJt,o 9r, ai u t v aY I o
[u zuu?EIY|tJl:U n-l:zu1&lnfl a[?1 n1:n1cl
femoral nerve block iruriu spinal
anesthesia 611u1:nan:sriunr:il?nmu1u 1 6J,c u u va f d v{? LrJ{fi a{ n1::v.0u n?1N:dfl LFI El tJ:vFlU fl ',l:
q
ilroraoa'l 1 .7-3.G rfi arfi erlrilnr:rir spinal
anesthesia tfi u',:adr',:tdgr dflfr:;urL?nld'tfr pethidine nr{.,:u:nuru{u o.e d'dru{ aot
n1:'[fi pethidine'[u z+ #rlru{a'o 42.6 finfinilA qv a tv
Lra16l'r tJ1:61 n n a1 fl 1: n nu Ldal ta fl u LFI
aaanflnn::illJtsR'lfl
abv d anrucallQ ufl o?au nfu u1 El Ltl\Yl fl LAAil
gq
- E v eo I Idnha:ts narursnl:h{Y{tl1u1ad?lrn
. u I €a a a
ri:flnind, unv u't EILLl\mg IYlEl1 o'Tlf,"ilAqmilQnu y t ^.Lf
da ) oYo
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;;;;;',,u",uu,,iifi"*,u q u
,u
tondl:o'l{oil1. Benyamin R, Trecot AM, Datta S. Opioid complications and side effects pain physician.
Opiod special issue 2008; 1 1 : 105-20.
Z. Edkin B, Spindler K, Flanagan J. Femoral nerve block as an altemative to parenteral
narcotics for pain control after anterior cruciate ligament reconstruction Arthroscopy.
The Journal of Arthroscopic & Related surgery 2001; 11: 404-9.
3. Tondrae AS, Nadkarni AV. Femoral nerue block for fractr-rred shaft of femur. Can Anestt
Soc J 1982; 29:270-1.
-E
d,vCfl?::nL:ut1:nut?ufi1:
4. Tierney E, LewisG, Hurtig JB, Johnson D. Femoral nerve block with bupivacaine0.25 percent for postoperative analgesia after open knee surgery. Can J Anaesth1987;5: 455-8.
Richman JM, Liu sS, courpas G, wong R, Rowlingson AJ, McGready J, et al.
Does continuous peripheral nerve block provide superior pain control to opioids?a meta-analysis. Anesth Analg 2006; 102. Z4B-ST.
Fanelli G, Casati A, Garancini P, Torri G. Nerve stimulator and multiple injection
technique for upper and lower limb blockade: failure rate, patient acceptance, andneurologic complications. Anesth Analg l ggg; BB: g47-50.
Hugh wA, spencer sL, Paul DW, craig sN, Brain Do. peripheral nerve blockimprove analgesia after total knee replacement surgery. Anesth Analg 1g9g; g7:
93-7.
Roxane F, Elisabeth VG, Giovanni G, Silv'ere B, Alain F,Zdravko G. Postoperative
analgesia with "3-in-1" femoral nerve block after prosthetic hip surgery. CanadianJournal of Anesthesia 1998; 45: S4-8.
9. Patel NJ, Flashburg MH, Parkin S, Grossman R. A regional anesthesia techenique
to general anesthesia for outpatient knee arthroscopy. Anesth Analg 1g86; 16 34-7.10. Heici F, Miiller N, Piepho T, Bares M, Giesa M, Dree p, et al. postoperative
analgesic efficacy of peripheral levobupivacaine and ropivacaine: a prospective,
randomized double-blind trial in patients after total knee arthroplasty. Anesth Analg
2OO8; 1 06:1 559-61 .
11. Francis VS, Spencer SL, Michael FM. The effect of single-injection femoral nerve
block versus continuous femoral nerve block after knee arthroplasty on hospital
length of stay and long-term function recovery within an established clinical pathway.
Anesth Analg 2006; 102: 1234-9.
12. Tarkkila P, Touminen M, Huntala J, Lindgren L. Comparison of intrathecal morphine
and continuous femoral 3-in 1 block for pain after major knee surgery under spinalanesthesia. European Journal of anesthesiology 2OO2: 15: 6-g.
13. Brian D, Michael B, Jhon DG, Robert AJ, Michael BS, Lundberg JF. A singleinjection ultrasound-assisted femoral nerue block provides side effect-sparing analgesia
when compared with intrathecal morphine in patients undergoing total knee
arthroplasty. Anesth Analg 2004;99: 1539-49.
14. Urbanek B, Duma A, Kimberger o, Huber G, Marhof er p, Zimpfer M, et al. onsettime, quality of blockade, and duration of three-in-one blocks with levobupivacaine
and bupivacaine. Anesth Analg 2003; 97: 8BB-92.
6.
7.
8.
Haxosnl:rir femoral nerve block daq o.r nJojr{uei levqbupivacainerfi oonornr:ilrqrdlnr:drffnnl6uuionirnrulu zl irlir.r
a,A v a Result of Femoral Nerve Blork with o.b% Levobupivacaine to Reduced Painilil 8 AUUm 1 il.F1.-ttJ.U. 2554 after Total Knee Replacement within zl hrs 4,)
15. Connor OA, Schug SA, Cardwell H. A comparison of the efficacy and safety of
morphine and pethidine as analgesia for suspected renal colic in the emergency
setting. Journal of Accident & Emergency Medicine 2000; 17: 261-4.
16. Unlugenc H, Vardar MA, Tetiker S. A Comparative study of the analgesic effect
of patient-controlled morphine, pethidine, and tramadol for postoperative pain
management after abdominal hysterectomy. Anesth Analg 2008; 106: 309-12.
17. Yosunkaya A, Tavlan A, Tuncer S, Rerslr R, Topal A, Okeslr S. Comparison of
the effects of intravenous and thoracic epidural patient-controlled analgesia with
morphine after upper abdominal surgery. Acta anesthesiologica Scandinavia 2003;
15: 271-9.
JvXn1fldfi t {aruafrufi1u?o.,:frd?el
{dd
Addition femoral block
(n=30)
mean (sD)
Spinal block alone
(n=30)
mean (sD)P value
o1q (fl)v
u1fiun (nn.)
drua.: (f,eJ.)
ASA classification (n,o/")
I
tr
tlt'lFI (n,%)
{'ru
u€,,:
:gEJ3[?A1nr:il'rriBr (u1fi )
nr:rfiarfian (ila.)
64.e (6.3)
65.7 (10.0)
156.e (6.2)
2 (6.7)
28 (e3.3)
5 (16.7)
25 (83.3)
112.2 (32.1)
1O1.7 (83.5)
63.3 (6.0)
62.7 (10.0)
155.3 (5.0)
2 (6.7)
28 (e3.3)
6 (20.0)
24 (80.0)
114.5 (2e.2)
88.3 (61.1)
0.349
o.247
0.306
1.000
0.739
o.772
0.483
jvmfl{fr 2 svnun'l?il?Ft
:vriunr:rhnAddition fernoral block
(n=30)
n (%)
Spinal block alone
(n=30)
n (Y")P value
vu9afi a.1fl1::s.1uFl?'t3JT6ln I {eJ.
mild pain ru
moderate pain
severe pain
mean (SD)vvy4
ila{n1::c.,tuFtl1tJTdn 1 2 ?tr.t.
mild pain {
, moderate pain
severe pain
mean (SD)uuya
fia{fl1TTs.:UFt?1il:6ln 1 6 {tJ.
mild pain
moderate pain
parn
mean (SD)vvlya
fi a{fl1::rnun?13J:61fl 24 AN.
mild pain {
moderate pain
severe pain
mean (SD)
0 (0)
16 (53.3)
14 (46.7)
7.1 (1.4)
30 (o)
0 (0)
0 (0)
2.1 (0.6)
24 (80.0)
4 (13.3)
2 (6.7)
3.5 (1.8)
16 (53.4)
13 (213.3)
1 (3.3)
4_5 (2.O)
16 (53.4)
13 (43.3)
1 (3.3)
3.e (1.3)
riaunr::sIunmru5fin
mild pain
moderate pain
severe pain
mean (SD)
0 (0)
18 (60.0)
12 (40.0)
6.8 (1.2)
17 (56.7)
e (30.0)
4 (13.3)
4.1 (2.1)
4 (13.3)
e (30.0)
17 (s6.7)
7.1 (2.1)
2 (6.7)
16 (53.3)
12 (40.0)
6.2 (2.3)
e (30.0)
1e (63.3)
2 (6.7)
4.4 (1.4)
0.409
<0.001
<0.00'l
0.003
o.'t47
ttd a ariud 1 il.n.-tx.fl. 2554Result of Femoul Nerve Blmk with o.e% Levobupivacaine to Reduced Pain
alter Total Knee Replacement within 2{ hrs
A oe e a rFt'l:1.0fi 3 nr:lfitrr pethidine A1n1T't1d[na.: UaE:rHut2aluau[:{ilUlulA
I
10il4{
Addition femoral block
(n=30)
mean (sD)
Spinal block alone
(n=30)
mean (sD)P value
nardlfr pethidine n{',:ur:n ltel';
?tu'rfr pethidine \u z+ tu. (iln.)A tv d
o1n1?nauld'aruiElu (n,%)
:rdu 0v
T&NU 1
:UFI"U 2
:ga"lj 3
a1n1:fru (n,%)fu
:sEtut'laluou LT{v{ u1u1n ('lu)
16.4 (1.0)
2e.2 (4.8)
17 (56.7)
0 (0)
1 (3.3)
12 (40.0)
0 (0)
6.2 (1.6)
e.6 (0.4)
71.8 (5.1)
3 (10.0)
2 (6.7)
3 (1o.0)
22 (73.3)
3 (10.0)
5.7 (1.4\
<0.001
<0.001
<0.001
o,237
0.233