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Continuous Femoral Nerve Block Reduces the Need for Manipulation Following Total Knee Arthroplasty

Peripheral nerve blocks improve both pain control and functional outcomes following total knee arthroplasty (TKA). However, few studies have examined the effects of different peripheral nerve block protocols on postoperative range of motion. The present study assessed the impact of a single-shot fem...

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Autores principales: Freccero, David M., Van Steyn, Peter, Joslin, Patrick M.N., Robbins, Claire E., Li, Xinning, Efremov, Kristian, Shukla, Pinak, Talmo, Carl T., Bono, James V.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Journal of Bone and Joint Surgery, Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9354944/
https://www.ncbi.nlm.nih.gov/pubmed/35935602
http://dx.doi.org/10.2106/JBJS.OA.21.00155
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author Freccero, David M.
Van Steyn, Peter
Joslin, Patrick M.N.
Robbins, Claire E.
Li, Xinning
Efremov, Kristian
Shukla, Pinak
Talmo, Carl T.
Bono, James V.
author_facet Freccero, David M.
Van Steyn, Peter
Joslin, Patrick M.N.
Robbins, Claire E.
Li, Xinning
Efremov, Kristian
Shukla, Pinak
Talmo, Carl T.
Bono, James V.
author_sort Freccero, David M.
collection PubMed
description Peripheral nerve blocks improve both pain control and functional outcomes following total knee arthroplasty (TKA). However, few studies have examined the effects of different peripheral nerve block protocols on postoperative range of motion. The present study assessed the impact of a single-shot femoral nerve block (SFNB) versus continuous femoral nerve block (CFNB) on postoperative range of motion and the need for subsequent manipulation following TKA. METHODS: We retrospective reviewed patient charts to identify patients who had undergone primary elective unilateral TKA by 2 surgeons at a high-volume orthopaedic specialty hospital over a 3-year period. A total of 1,091 patients received either SFNB or CFNB and were included in the data analysis. Identical surgical techniques, postoperative oral analgesic regimens, and rehabilitation protocols were used for all patients. Patients with <90° of flexion at 6 weeks postoperatively underwent closed manipulation under anesthesia (MUA). RESULTS: Overall, 608 patients (55.7%) received CFNB and 483 patients (44.3%) received SFNB. Overall, 94 patients (8.6%) required postoperative manipulation for stiffness, including 36 (5.9%) in the CFNB group and 58 (12%) in the SFNB group. The 50% reduction in the need for manipulation in the CFNB group was independent of primary surgeon (p > 0.05). No significant differences were observed between the groups in terms of postoperative range of motion, either at the time of discharge or at 6 weeks postoperatively. A history of knee surgery, decreased preoperative range of motion, and decreased range of motion at the time of discharge were significantly associated with the need for further MUA (p = 0.0002, p < 0.0001, and p < 0.0001, respectively). CONCLUSIONS: Despite similar final postoperative range of motion between patients in both groups, our results suggest that CFNB may be superior to SFNB for reducing the need for postoperative manipulation after primary TKA. Furthermore, a history of ipsilateral knee surgery, decreased preoperative range of motion, and decreased range of motion at the time of discharge were identified as independent risk factors for postoperative stiffness requiring MUA after primary TKA. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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spelling pubmed-93549442022-08-05 Continuous Femoral Nerve Block Reduces the Need for Manipulation Following Total Knee Arthroplasty Freccero, David M. Van Steyn, Peter Joslin, Patrick M.N. Robbins, Claire E. Li, Xinning Efremov, Kristian Shukla, Pinak Talmo, Carl T. Bono, James V. JB JS Open Access Scientific Articles Peripheral nerve blocks improve both pain control and functional outcomes following total knee arthroplasty (TKA). However, few studies have examined the effects of different peripheral nerve block protocols on postoperative range of motion. The present study assessed the impact of a single-shot femoral nerve block (SFNB) versus continuous femoral nerve block (CFNB) on postoperative range of motion and the need for subsequent manipulation following TKA. METHODS: We retrospective reviewed patient charts to identify patients who had undergone primary elective unilateral TKA by 2 surgeons at a high-volume orthopaedic specialty hospital over a 3-year period. A total of 1,091 patients received either SFNB or CFNB and were included in the data analysis. Identical surgical techniques, postoperative oral analgesic regimens, and rehabilitation protocols were used for all patients. Patients with <90° of flexion at 6 weeks postoperatively underwent closed manipulation under anesthesia (MUA). RESULTS: Overall, 608 patients (55.7%) received CFNB and 483 patients (44.3%) received SFNB. Overall, 94 patients (8.6%) required postoperative manipulation for stiffness, including 36 (5.9%) in the CFNB group and 58 (12%) in the SFNB group. The 50% reduction in the need for manipulation in the CFNB group was independent of primary surgeon (p > 0.05). No significant differences were observed between the groups in terms of postoperative range of motion, either at the time of discharge or at 6 weeks postoperatively. A history of knee surgery, decreased preoperative range of motion, and decreased range of motion at the time of discharge were significantly associated with the need for further MUA (p = 0.0002, p < 0.0001, and p < 0.0001, respectively). CONCLUSIONS: Despite similar final postoperative range of motion between patients in both groups, our results suggest that CFNB may be superior to SFNB for reducing the need for postoperative manipulation after primary TKA. Furthermore, a history of ipsilateral knee surgery, decreased preoperative range of motion, and decreased range of motion at the time of discharge were identified as independent risk factors for postoperative stiffness requiring MUA after primary TKA. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. Journal of Bone and Joint Surgery, Inc. 2022-08-04 /pmc/articles/PMC9354944/ /pubmed/35935602 http://dx.doi.org/10.2106/JBJS.OA.21.00155 Text en Copyright © 2022 The Authors. Published by The Journal of Bone and Joint Surgery, Incorporated. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Scientific Articles
Freccero, David M.
Van Steyn, Peter
Joslin, Patrick M.N.
Robbins, Claire E.
Li, Xinning
Efremov, Kristian
Shukla, Pinak
Talmo, Carl T.
Bono, James V.
Continuous Femoral Nerve Block Reduces the Need for Manipulation Following Total Knee Arthroplasty
title Continuous Femoral Nerve Block Reduces the Need for Manipulation Following Total Knee Arthroplasty
title_full Continuous Femoral Nerve Block Reduces the Need for Manipulation Following Total Knee Arthroplasty
title_fullStr Continuous Femoral Nerve Block Reduces the Need for Manipulation Following Total Knee Arthroplasty
title_full_unstemmed Continuous Femoral Nerve Block Reduces the Need for Manipulation Following Total Knee Arthroplasty
title_short Continuous Femoral Nerve Block Reduces the Need for Manipulation Following Total Knee Arthroplasty
title_sort continuous femoral nerve block reduces the need for manipulation following total knee arthroplasty
topic Scientific Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9354944/
https://www.ncbi.nlm.nih.gov/pubmed/35935602
http://dx.doi.org/10.2106/JBJS.OA.21.00155
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