The sit-to-stand movement: A clinical evaluation tool for knee and hip arthroplasty patients.

BACKGROUND: A continuous femoral nerve block is frequently used as an adjunct therapy after total knee arthroplasty (TKA). However, there is still debate on its benefits. METHODS: In this prospective, randomized study, patients received a basic analgesic regimen of paracetamol and dicloflenac for the first 48 h postoperatively. In addition, the study group received a continuous femoral nerve block. A morphine patient-controlled analgesia pump was also available as a rescue analgesic to all the patients. Patients’ numeric rating scores for pain, the amount of morphine consumed and its side effects during the first 48 h were recorded. Knee flexion angles achieved during the first week were registered. Three months postoperatively, patients completed Western Ontario and McMaster Universities Osteoarthritis Index and Knee Society Score. RESULTS: The study group (n=27) had less pain (P=0.0016) during the first 48 h, was more satisfied with the analgesia (P<0.001) and used less morphine (P=0.007) compared with the control group (n=26). Fewer patients were nauseated, vomited or were drowsy in the study group (P=0.001). Also, the study group achieved better knee flexion in the first 6 days after surgery (P=0.001), with more patients reaching 90° flexion than the control group. However, after 3 months, there were no significant functional differences between the groups. CONCLUSION: A continuous femoral nerve block leads to better analgesia, less morphine consumption and less morphine-related side effects after TKA. Early functional recovery is improved, resulting in more patients reaching 90° knee flexion after 6 days. However, after 3 months, no significant functional benefits were found. Introduction Total knee arthroplasty (TKA) often produces severe pain that may impair postoperative recovery of the patient. Reduction of pain may be an important factor in early rehabilitation.(1;2) However, adequate analgesia is difficult to achieve with opioids,(3) even in combination with nonsteroidal anti-inflammatory drugs.(4) Additional analgesic methods such as single shot and continuous nerve blocks have frequently been used and studied. (4-7) Previous studies have reported analgesic benefits of a 3-in-1 nerve block after TKA. (6-9) However, it has also been observed that a 3-in-1 block (further referred to in the text as a femoral nerve block) is not always complete, as it does not constantly produce anaesthesia of the obturator nerve.(10;11) Also, the back of the knee, innervated by the sciatic nerve remains unblocked with this technique and this can be the painful area after TKA in some patients.(12-14) Reduction in postoperative pain and opioid related side effects with the use of femoral nerve blocks is well recognized, but from previous studies it is not evident that better analgesia leads to better knee function in TKA patients.(6) The primary goal of our study was to examine the intensity of pain experienced and the amount of morphine used by patients who did receive a continuous femoral nerve block,

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