Outcome of femoral nerve block in patients undergoing total knee arthroplasty at Muhimbili orthopaedic institute in Dar es salaam, Tanzania

Abstract

ABSTRACT Background Total knee arthroplasty is among the advanced orthopaedic surgical procedures and the trend of this intervention has been increasing over the last 2 to 3 decades worldwide. The major indication for total knee arthroplasty is osteoarthritis. Although the trend is growing up, the major challenge is on controlling postoperative pain. Total Knee Arthroplasty is regarded as among the painful procedure for up to 72hours postoperatively. In different parts of the world, femoral nerve block has been shown to improve pain management, especially when used in the multimodal approach in TKA patients. In our setting, no study has been done to evaluate the benefits of femoral nerve block versus conventional systemic opioids in the management of pain in patients post Total Knee Arthroplasty Objective To determine the outcome of femoral nerve block for postoperative analgesia in patients undergoing TKA at MOI Materials and Methods This was a hospital-based prospective randomized comparative study. The study population constituted 72 adult patients between 18 and 85yrs of age, who underwent TKA. Patients were randomized into two groups, each group having 36patients. During surgery, all patients received standard general anaesthesia. In the post-anaesthesia care unit, one group received single-shot femoral nerve block with 30ml of 0.25% Bupivacaine under ultrasound guidance and the other group received conventional systemic opioids for pain management. One patient was drop out in femoral nerve block due to failure of the block. Diclofenac 75mg was given to all patients as per schedule for preemptive analgesia. Pethidine 100mg 6hrly was given intramuscularly to the non-femoral block group. Also, pethidine given to patients receives femoral nerve block group once they started to complain pain NRS of> 4. Data were collected from the written questionnaire transferred and analyzed with SPSS computer program version 20.0. The continuous variables were presented as mean, standard xi deviation and categorical variables presented as a percentage. Associations were tested via Chi-square for categorical variables and t-test for continuous variables. A 95% confidence interval and P-value of 0.05 was used for statistical significance.