• Harsha Shanthanna, Medha Huilgol, Vinay Kumar Manivackam, and Amjad Maniar.
• Department of Anesthesiology and Pain Medicine, McMaster University, Health Sciences Centre 2U1, Hamilton, Ontario, Canada.
• Indian J Anaesth. 2012 May 1; 56 (3): 270-5.

BackgroundRegional analgesia is widely used for total knee replacement surgeries (TKR) as it has lesser side-effects and better analgesic efficacy when compared with traditional oral analgesics. Peripheral nerve blockade has also been utilized, including continuous infusion techniques. With the use of ultrasound, the needle and catheter placement can be done accurately under real-time guidance. This may prove a more suitable approach compared with the epidural technique.AimsPost-operative analgesia in TKR patients was compared between continuous epidural analgesia (CEA) and continuous femoral block (CFB) techniques. VAS scores and use of rescue analgesic were used as parameters. Secondary aims included comparison of rehabilitation scores and side-effects in the form hypotension, vomiting, itching and urinary retention.Settings And DesignRandomised, controlled, non-blinded study done in a tertiary care private hospital.MethodsForty-two patients fulfilling the study criteria were randomised into the CEA and CFB groups. In total, four patients: three in the CFB group and one in the CEA group, were excluded because of catheter migration.Statistical AnalysisMean VAS score at 6, 6-24, 24-48 and 48-72 h were considered. Significance was assessed at the 5% level.Results And ConclusionVAS scores were significantly high (P=0.001) in the femoral group at 6 h, after which there was a declining trend, and scores were essentially similar from 24 h. Common side-effects were more common in the CEA group. Our study shows that CFB gives equivalent analgesia compared with CEA in TKR patients with clinically meaningful decrease in side-effects.

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