• Scott L Sugar, Larry R Hutson, Patrick Shannon, Leslie C Thomas, and Bobby D Nossaman.
• Department of Anesthesiology, Ochsner Clinic Foundation, New Orleans, LA.
• Ochsner J. 2011 Jan 1;11(1):17-21.

BackgroundBecause newer anticoagulation strategies for total knee replacement present potentially increased risk of neuraxial analgesia, there is movement away from using patient-controlled epidural analgesia (PCEA) for pain control. This concern opens the door for other regional modalities in postoperative analgesia, including the use of extended-release epidural morphine (EREM) combined with a femoral nerve block (FNB).MethodsThis study was a prospective observational chart review with the use of recent historical controls in patients undergoing unilateral total knee replacement. Outcomes of interest were 0-, 24-, and 48-hour postoperative pain scores using the visual analog scale (VAS); incidence of side effects; and time spent in the postanesthesia care unit (PACU).ResultsPostoperative pain scores at 24 and 48 hours in the EREM and FNB group (n  =  14; 2.6 ± 0.6 and 5.0 ± 0.9, respectively) were comparable to the PCEA group (n  =  14; 3.8 ± 0.6 and 4.2 ± 0.9). The PACU time was shorter in the EREM and FNB group (2.4 ± 0.3 hours) compared with PCEA (3.6 ± 0.3 hours, P  =  .02). No statistically significant difference was found in the incidence of side effects between the 2 groups.ConclusionsThe VAS scores at 24 and 48 hours indicate that EREM and FNB provide comparable analgesia to PCEA. The trend toward shorter PACU times represents an opportunity for cost-identification analysis. The study data are limited by their observational nature and the small number of patients involved; nevertheless, this study demonstrates a therapeutic equivalence to PCEA that may be more cost effective.

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