Influence of Femoral Nerve Block on Quadriceps Strength Recovery After Total Knee Replacement
Bibliographic record
Abstract
Background: Total knee replacement (TKR) is a frequent and effective surgery for knee osteoarthritis. Postoperative pain is under concern and can be relieved by different methods, including femoral nerve block (FNB). The efficacy of FNB on pain relief was associated with the absence of clinical impact when measured with the range of motion (ROM). Recent studies suggest that the quadriceps strength is the best indicator of functional recovery after TKR. The goal of this study is to compare the quadriceps strength recovery after TKR according to the kind of analgesia (patient control analgesia (PCA) with or without FNB) Hypothesis: the FNB delays the QSR at short and mid-term follow-up. Methods: Prospective randomized trial with single-blind assessment involving 135 patients admitted for TKR in an academic center. Randomization into one of the three following groups: A) Continuous FNB 48h + PCA B) Single-shot FNB and PCA C) PCA alone. Groups were comparable for demographic and surgical data. The FNB was realised and controlled (electric stimulation) by an expert anesthesiologist before the surgery. Follow-up standardised in all groups with blinded assessors. Quadriceps strength measured with a validated dynamometer at 6 weeks, 6 and 12 months. Secondary outcomes included clinical evaluation (ROM, pain, stability) and functional scores (SF-36 v2, WOMAC). Multivariate analysis (Kruskal-Wallis, Mann-Whitney) for main outcomes and Spearman factor for correlation. Sample size calculated for alpha 5% and study power 80%. Results: 111 patients available for 6 weeks follow-up (A-B-C:40-38-33) and 104 (36-36-32) at 6 and 12 months. Two patients in group B excluded for direct fall in the first postoperative week with extensor mechanism rupture and peri-prosthetic femoral fracture. QSR is significantly decreased in patients with FNB at all times (mean, 95% IC): 6 weeks (A 51.3%, 44.1–58.5; B 62.2%, 55.2–69.2; C 77.4%, 70.7–84.1; p Conclusion: Femoral nerve block has a negative influence on QSR at short and mid-term follow-up and delays the rehabilitation after TKR. QSR is actually the most sensitive indicator of functional recovery after TKR and is better related to functional tests than ROM. This can explain the harmlessness of FNB in previous studies. FNB should not yet be recommended for analgesia after TKR.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".