Abstract

EPIDURAL ANALGESIA VERSUS FEMORAL NERVE BLOCK AFTER TOTAL KNEE REPLACEMENT: COMPARISON OF EFFICACY AND SAFETY

*Dr. Venkateswaran Sundararajan, Dr. Ramila Jamaliya, Dr. Mohit Dave, Dr. Janvi Patel and Dr. Daxa Oza

Abstract

Aim of Study: To compare procedure of post-operative pain relief in TKR between epidural analgesia and femoral nerve block. We compared analgesic efficacy, side effects, post-operative knee rehabilitation and duration of hospital stay. Materials and Methods: Fifty cases posted for elective unilateral TKR under spinal anaesthesia were randomly divided into two groups. Patients in group E received epidural analgesia (0.125% bupivacaine 15 ml) and group F received femoral nerve block (0.125% bupivacaine 15 ml). Analgesic efficacy in term of onset of action & duration of analgesia was assessed by using VAS (0 to 10cm) for 24hr. No of rescue analgesic doses and side effects were also assessed. Results: in group E: VAS score >6 in epidural (7.31+/- 0.52) and in group F: VAS score (6.85 +/-0.34) which suggest longer duration of pain relief in epidural analgesia. Total incidence of side effects 27% in case of group E compared to 5% in group F. Hypotension, Nausea,. Itching, Back pain, are common side effects in group E. Patient satisfaction was greater with group F. Although post-operative knee rehabilitation and hospital stay were not different. Conclusion: There is longer duration of pain relief in epidural analgesia but group F represents optimal analgesia with fewer side effects and greater patient satisfaction. Femoral block is safe, cheap & easy. Required less skill, equipment and cost effective. So for age related safety purpose, femoral block has higher value for pain relief in TKR even than epidural gives more analgesia.

Keywords: Total knee replacement, post-operative analgesia, Epidural analgesia, Femoral nerve block.