Fascia Iliaca Compartment Block For Early Analgesia Following Total Knee Anthroplasty

Object:To observe the effects on reducing early postoperative pain and complications of fascia iliaca compartment block in patients with total knee anthroplasty, and to evaluate its efficacy and safety.Methods:After approval by the hospital ethics committee, written informed patient consent, forty patients undergoing total knee anthroplasty participated in this prospective, randomized, placebo-controlled, single-blinded study. Patients aged 56 to 75 years and with weight 52 to 75Kg, who without compound injury, were randomly divided into two groups:group F (n=20) and group M (n=20). The random allocation sequence was generated by random permutation table. In group F, patients received fascia iliaca compartment block with 0.2% ropivacaine,0.6mL/Kg, and in group M, the same volume 0.9% NaCl solution instead of ropivacaine. Adjuvant analgesia was intravenous patient-controlled analgesia (PCA) with morphine 500μg/mL, delivering 2ml doses with a 10-min lockout period and a maximum dose of 3mg in one hour, PCA was applied to patients in two groups constantly until 48h after operation. Intramuscular morphine 0.1-0.2mg/Kg was given as a remedial treatment if the severe pain not improved by PCA. Postoperatively pain was evaluated by visual analogue scale (VAS) pain scores ranging from 0 (no pain) to 10 (worst imaginable pain). VAS pain scores at rest (RVAS) were determined at pre-block(T0), as well as lh(T1),3h(T2),6h(T3),12h(T4),24h(T5), 48h(T6) and 72h(T7) after block. Considering that movement was prohibited in the first 12h after TKA, VAS pain scores during passive move (PVAS) were determined only at T4-T7. Consumption of morphine were recorded respectively in the periods of 0-12h, 12-24h,24-36h and 36-48h after operation. As well, the 48h total PCA morphine consumption and the dosages of remedial treatment were recorded. Meanwhile, the incidence of complications or side effects including nausea, vomiting, respiratory inhibition, hypotension and urinary retention were recorded throughout this study.Results:There were no significant demographic differences between the two groups. The RVAS pain scores at T1-T5 as well as the PVAS pain scores at T4 and T5 in group F were significantly lower than those in group M (p<0.05). In the periods of 0-12h,12-24h and 24-36h after surgery morphine consumption were significantly reduced in group F compared with group M (p<0.05). Furthermore, the dosages of remedial treatment using intramuscular morphine and the 48h total PCA morphine consumption in group F were also less than in group M (p<0.05). The incidence of nausea, vomiting, respiratory inhibition and urinary retention were significantly less frequent in group F (p<0.05), but no remarkably difference between two groups in hypotension. Conclusion:Fascia iliaca compartment block with 0.2%ropivacaine can provide better pain relief, lower opiods consumption and with fewer side effects, therefore, it is an effective, safe and convenient treatment for postoperative early pain in total knee anthroplasty patients.