Postoperative Analgesia After Total Knee Replacement: The Effect of an Obturator Nerve Block Added to the Femoral 3-in-1 Nerve Block
Femoral nerve block (FNB) does not consistently produce anesthesia of the obturator nerve. In this single-blind, randomized, controlled study we added a selective obturator nerve block (ONB) to FNB to analyze its influence on postoperative analgesia after total knee replacement (TKR). Before general...
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| Veröffentlicht in: | Anesthesia and analgesia 2004-07, Vol.99 (1), p.251-254 |
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| container_title | Anesthesia and analgesia |
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| creator | Macalou, D. Trueck, S. Meuret, P. Heck, M. Vial, F. Ouologuem, S. Capdevila, X. Virion, J.-M. Bouaziz, H. |
| description | Femoral nerve block (FNB) does not consistently produce anesthesia of the obturator nerve. In this single-blind, randomized, controlled study we added a selective obturator nerve block (ONB) to FNB to analyze its influence on postoperative analgesia after total knee replacement (TKR). Before general anesthesia, 90 patients undergoing TKR received FNB (Group 1), FNB and selective ONB (Group 2), or placebo FNB (Group 3). Postoperative analgesia was further provided by morphine IV via patient-controlled analgesia. Analgesic efficacy and side effects were recorded in the first 6 h after surgery. Adductor strength decreased by 18% ± 9% in Group 1 and by 78% ± 22% in Group 2 (P < 0.0001). Total morphine consumption was reduced in Group 2 compared with Groups 1 and 3 (P ≤ 0.0001). Patients in Group 2 reported lower pain scores than those in Groups 1 and 3 (P = 0.0003). The incidence of nausea was more frequent in Groups 1 and 3 (P = 0.01). We conclude that FNB does not produce complete anesthesia of the obturator nerve. Single-shot FNB does not provide additional benefits on pain at rest over opioids alone in the early postoperative period. The addition of an ONB to FNB improves postoperative analgesia after TKR. |
| doi_str_mv | 10.1213/01.ANE.0000121350.09915.84 |
| format | Article |
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In this single-blind, randomized, controlled study we added a selective obturator nerve block (ONB) to FNB to analyze its influence on postoperative analgesia after total knee replacement (TKR). Before general anesthesia, 90 patients undergoing TKR received FNB (Group 1), FNB and selective ONB (Group 2), or placebo FNB (Group 3). Postoperative analgesia was further provided by morphine IV via patient-controlled analgesia. Analgesic efficacy and side effects were recorded in the first 6 h after surgery. Adductor strength decreased by 18% ± 9% in Group 1 and by 78% ± 22% in Group 2 (P < 0.0001). Total morphine consumption was reduced in Group 2 compared with Groups 1 and 3 (P ≤ 0.0001). Patients in Group 2 reported lower pain scores than those in Groups 1 and 3 (P = 0.0003). The incidence of nausea was more frequent in Groups 1 and 3 (P = 0.01). We conclude that FNB does not produce complete anesthesia of the obturator nerve. Single-shot FNB does not provide additional benefits on pain at rest over opioids alone in the early postoperative period. The addition of an ONB to FNB improves postoperative analgesia after TKR.</description><identifier>ISSN: 0003-2999</identifier><identifier>EISSN: 1526-7598</identifier><identifier>DOI: 10.1213/01.ANE.0000121350.09915.84</identifier><identifier>PMID: 15281539</identifier><identifier>CODEN: AACRAT</identifier><language>eng</language><publisher>Hagerstown, MD: International Anesthesia Research Society</publisher><subject>Aged ; Analgesia, Patient-Controlled ; Analgesics, Opioid - administration & dosage ; Analgesics, Opioid - therapeutic use ; Anesthesia ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Arthroplasty, Replacement, Knee ; Biological and medical sciences ; Female ; Femoral Nerve ; Humans ; Male ; Medical sciences ; Morphine - administration & dosage ; Morphine - therapeutic use ; Nerve Block ; Obturator Nerve ; Pain Measurement ; Pain, Postoperative - drug therapy ; Postoperative Nausea and Vomiting - epidemiology ; Single-Blind Method</subject><ispartof>Anesthesia and analgesia, 2004-07, Vol.99 (1), p.251-254</ispartof><rights>International Anesthesia Research Society</rights><rights>2004 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5900-5b8019f6e20c1a814a6b1eba343b02b0fef098c3f99f8848e2491a5726011bf83</citedby><cites>FETCH-LOGICAL-c5900-5b8019f6e20c1a814a6b1eba343b02b0fef098c3f99f8848e2491a5726011bf83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttp://ovidsp.ovid.com/ovidweb.cgi?T=JS&NEWS=n&CSC=Y&PAGE=fulltext&D=ovft&AN=00000539-200407000-00050$$EHTML$$P50$$Gwolterskluwer$$H</linktohtml><link.rule.ids>314,777,781,4595,27905,27906,65212</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=15913242$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15281539$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Macalou, D.</creatorcontrib><creatorcontrib>Trueck, S.</creatorcontrib><creatorcontrib>Meuret, P.</creatorcontrib><creatorcontrib>Heck, M.</creatorcontrib><creatorcontrib>Vial, F.</creatorcontrib><creatorcontrib>Ouologuem, S.</creatorcontrib><creatorcontrib>Capdevila, X.</creatorcontrib><creatorcontrib>Virion, J.-M.</creatorcontrib><creatorcontrib>Bouaziz, H.</creatorcontrib><title>Postoperative Analgesia After Total Knee Replacement: The Effect of an Obturator Nerve Block Added to the Femoral 3-in-1 Nerve Block</title><title>Anesthesia and analgesia</title><addtitle>Anesth Analg</addtitle><description>Femoral nerve block (FNB) does not consistently produce anesthesia of the obturator nerve. In this single-blind, randomized, controlled study we added a selective obturator nerve block (ONB) to FNB to analyze its influence on postoperative analgesia after total knee replacement (TKR). Before general anesthesia, 90 patients undergoing TKR received FNB (Group 1), FNB and selective ONB (Group 2), or placebo FNB (Group 3). Postoperative analgesia was further provided by morphine IV via patient-controlled analgesia. Analgesic efficacy and side effects were recorded in the first 6 h after surgery. Adductor strength decreased by 18% ± 9% in Group 1 and by 78% ± 22% in Group 2 (P < 0.0001). Total morphine consumption was reduced in Group 2 compared with Groups 1 and 3 (P ≤ 0.0001). Patients in Group 2 reported lower pain scores than those in Groups 1 and 3 (P = 0.0003). The incidence of nausea was more frequent in Groups 1 and 3 (P = 0.01). We conclude that FNB does not produce complete anesthesia of the obturator nerve. Single-shot FNB does not provide additional benefits on pain at rest over opioids alone in the early postoperative period. The addition of an ONB to FNB improves postoperative analgesia after TKR.</description><subject>Aged</subject><subject>Analgesia, Patient-Controlled</subject><subject>Analgesics, Opioid - administration & dosage</subject><subject>Analgesics, Opioid - therapeutic use</subject><subject>Anesthesia</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Arthroplasty, Replacement, Knee</subject><subject>Biological and medical sciences</subject><subject>Female</subject><subject>Femoral Nerve</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Morphine - administration & dosage</subject><subject>Morphine - therapeutic use</subject><subject>Nerve Block</subject><subject>Obturator Nerve</subject><subject>Pain Measurement</subject><subject>Pain, Postoperative - drug therapy</subject><subject>Postoperative Nausea and Vomiting - epidemiology</subject><subject>Single-Blind Method</subject><issn>0003-2999</issn><issn>1526-7598</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpNkcFu1DAQhi0EotvCKyALCW4J48RJ7N5CtQVE1SK0nC3HO2ZDvfHWdqi498HxdldqfbFm9M030vyEvGdQsorVn4CV_fWyhPz2dQMlSMmaUvAXZMGaqi26RoqXZJGBuqiklCfkNMY_ex5E-5qcZEiwppYL8vDDx-R3GHQa_yLtJ-1-Yxw17W3CQFc-aUe_T4j0J-6cNrjFKZ3T1Qbp0lo0iXpL9URvhjRnhw_0GkMWfXbe3NJ-vcY1TZ6mzF_i1odsq4txKthz7g15ZbWL-Pb4n5Ffl8vVxdfi6ubLt4v-qjCNBCiaQQCTtsUKDNOCcd0ODAdd83qAagCLFqQwtZXSCsEFVlwy3XRVC4wNVtRn5OPBuwv-bsaY1HaMBp3TE_o5qrbtuOy6JoPnB9AEH2NAq3Zh3OrwTzFQ-5srYCpnoJ4yUI8ZKMHz8LvjlnnY4vpp9Hj0DHw4Ajoa7WzQkxnjM06yuuJV5viBu_cuhxFv3XyPQW1Qu7R5XA1ZV1QAHLpcFPsG1P8Bwaudyw</recordid><startdate>20040701</startdate><enddate>20040701</enddate><creator>Macalou, D.</creator><creator>Trueck, S.</creator><creator>Meuret, P.</creator><creator>Heck, M.</creator><creator>Vial, F.</creator><creator>Ouologuem, S.</creator><creator>Capdevila, X.</creator><creator>Virion, J.-M.</creator><creator>Bouaziz, H.</creator><general>International Anesthesia Research Society</general><general>Lippincott</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20040701</creationdate><title>Postoperative Analgesia After Total Knee Replacement: The Effect of an Obturator Nerve Block Added to the Femoral 3-in-1 Nerve Block</title><author>Macalou, D. ; Trueck, S. ; Meuret, P. ; Heck, M. ; Vial, F. ; Ouologuem, S. ; Capdevila, X. ; Virion, J.-M. ; Bouaziz, H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5900-5b8019f6e20c1a814a6b1eba343b02b0fef098c3f99f8848e2491a5726011bf83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Aged</topic><topic>Analgesia, Patient-Controlled</topic><topic>Analgesics, Opioid - administration & dosage</topic><topic>Analgesics, Opioid - therapeutic use</topic><topic>Anesthesia</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Arthroplasty, Replacement, Knee</topic><topic>Biological and medical sciences</topic><topic>Female</topic><topic>Femoral Nerve</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Morphine - administration & dosage</topic><topic>Morphine - therapeutic use</topic><topic>Nerve Block</topic><topic>Obturator Nerve</topic><topic>Pain Measurement</topic><topic>Pain, Postoperative - drug therapy</topic><topic>Postoperative Nausea and Vomiting - epidemiology</topic><topic>Single-Blind Method</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Macalou, D.</creatorcontrib><creatorcontrib>Trueck, S.</creatorcontrib><creatorcontrib>Meuret, P.</creatorcontrib><creatorcontrib>Heck, M.</creatorcontrib><creatorcontrib>Vial, F.</creatorcontrib><creatorcontrib>Ouologuem, S.</creatorcontrib><creatorcontrib>Capdevila, X.</creatorcontrib><creatorcontrib>Virion, J.-M.</creatorcontrib><creatorcontrib>Bouaziz, H.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Anesthesia and analgesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Macalou, D.</au><au>Trueck, S.</au><au>Meuret, P.</au><au>Heck, M.</au><au>Vial, F.</au><au>Ouologuem, S.</au><au>Capdevila, X.</au><au>Virion, J.-M.</au><au>Bouaziz, H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Postoperative Analgesia After Total Knee Replacement: The Effect of an Obturator Nerve Block Added to the Femoral 3-in-1 Nerve Block</atitle><jtitle>Anesthesia and analgesia</jtitle><addtitle>Anesth Analg</addtitle><date>2004-07-01</date><risdate>2004</risdate><volume>99</volume><issue>1</issue><spage>251</spage><epage>254</epage><pages>251-254</pages><issn>0003-2999</issn><eissn>1526-7598</eissn><coden>AACRAT</coden><abstract>Femoral nerve block (FNB) does not consistently produce anesthesia of the obturator nerve. In this single-blind, randomized, controlled study we added a selective obturator nerve block (ONB) to FNB to analyze its influence on postoperative analgesia after total knee replacement (TKR). Before general anesthesia, 90 patients undergoing TKR received FNB (Group 1), FNB and selective ONB (Group 2), or placebo FNB (Group 3). Postoperative analgesia was further provided by morphine IV via patient-controlled analgesia. Analgesic efficacy and side effects were recorded in the first 6 h after surgery. Adductor strength decreased by 18% ± 9% in Group 1 and by 78% ± 22% in Group 2 (P < 0.0001). Total morphine consumption was reduced in Group 2 compared with Groups 1 and 3 (P ≤ 0.0001). Patients in Group 2 reported lower pain scores than those in Groups 1 and 3 (P = 0.0003). The incidence of nausea was more frequent in Groups 1 and 3 (P = 0.01). We conclude that FNB does not produce complete anesthesia of the obturator nerve. Single-shot FNB does not provide additional benefits on pain at rest over opioids alone in the early postoperative period. The addition of an ONB to FNB improves postoperative analgesia after TKR.</abstract><cop>Hagerstown, MD</cop><pub>International Anesthesia Research Society</pub><pmid>15281539</pmid><doi>10.1213/01.ANE.0000121350.09915.84</doi><tpages>4</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Analgesia, Patient-Controlled Analgesics, Opioid - administration & dosage Analgesics, Opioid - therapeutic use Anesthesia Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Arthroplasty, Replacement, Knee Biological and medical sciences Female Femoral Nerve Humans Male Medical sciences Morphine - administration & dosage Morphine - therapeutic use Nerve Block Obturator Nerve Pain Measurement Pain, Postoperative - drug therapy Postoperative Nausea and Vomiting - epidemiology Single-Blind Method |
| title | Postoperative Analgesia After Total Knee Replacement: The Effect of an Obturator Nerve Block Added to the Femoral 3-in-1 Nerve Block |
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