The Effect of Femoral Nerve Block on Opioid Consumption among Patient’s who Underwent Total Knee Replacement under Spinal Anesthesia
| dc.contributor.author | Kulaib, Sameh | |
| dc.date.accessioned | 2022-09-29T11:37:39Z | |
| dc.date.available | 2022-09-29T11:37:39Z | |
| dc.date.issued | 2019-02-14 | |
| dc.description.abstract | Background Total knee replacement (TKR) is a common surgical procedure which has become the treatment of choice for people with intractable joint pain and disability. It’s a clinically efficacious and cost-effective intervention, with high rates of success in terms of alleviating pain and improving function in patients with advanced arthritis of the knee. The post-operative complications may delay the mobility and discharge. There are many complications such as traumatic to nerves or blood vessels in the leg, dislocation of the prosthesis, allergic to the cement material and pain post operation. Pain management is an important part of recovery. The multi module post-operative pain management continuous epidural, lumbar plexus, and femoral or sciatic nerve blocks improve postoperative pain management and reduce opioid consumption. Femoral nerve block (FNB) is one of the methods used to decreased opioid consumption. A femoral nerve block can be used to provide anesthesia for the anterior thigh, knee, and a small part of the medial foot. It is typically used in conjunction with other lower extremity blocks. It may also be used for postoperative pain relief following knee surgery. Aims To assess the efficacy of FNB in reducing pain among spinal anesthesia total knee replacement, the efficacy of FNB in reducing post-operative nausea and vomiting (PONV) among spinal anesthesia total knee replacement, and to assess the efficacy of femoral nerve block in reducing opioid consumption post-operative spinal anesthesia total knee replacement. Methods A randomized controlled trial (RCT) conducted at Rafidia hospital. The patients participating in the trial were randomly assigned to either group received the femoral nerve block under investigation (intervention group) or to a group did not receive treatment (control group). The sample size based on α 0.05 and affect referred size and power 0.80. The estimated sample size is (100 participants). Results Of the 100 subjects who underwent unilateral total knee arthroplasty (TKA) included in this study, 44% (n = 44) of subjects had received a femoral nerve block (FNB) prior to total knee arthroplasty (TKA), while 56% (n = 56) did not receive a femoral nerve block prior to surgery. The two groups, femoral nerve block vs. non-femoral nerve block, showed differences in the percentage of reported postoperative surgery outcome parameters variables including nausea, vomiting, and drowsiness. Non-femoral nerve block group reported higher percentage of post-operative surgery nausea than femoral nerve block group at all post-operative surgery measured time intervals except at the 4th post-operative hour. The percentage of vomiting by non-femoral nerve block group at the 4th and 24th post-operative hours was lower (26.8% & 3.6%) than the reported percentage of vomiting by femoral nerve block group (27.3% & 4.5%). The two groups, femoral nerve block vs. non-femoral nerve block, showed no statistically differences in the mean of systolic blood pressure or diastolic blood pressure at pre and all post-operative surgery measured time intervals except at the 12th post-operative hour for systolic and diastolic blood pressure (p value < 0.05) and pre-operative heart rate (p value < 0.05). The mean of systolic blood pressure and diastolic blood pressure at 12th hour post-operative were 120.5 ± 12.9 mmHg and 70.0 ± 7.1 mmHg for non-femoral nerve block group and were 128.1±9.3 mmHg and 72.7±4.0 mmHg for femoral nerve block group The two groups, femoral nerve block vs. non-femoral nerve block, showed no statistically differences in the mean of heart rate at all post-operative surgery measured time intervals except at the pre-operative heart rate (p value < 0.05). The two groups, femoral nerve block vs. non-femoral nerve block, showed no statistically differences in the mean of O2 saturation at pre and all post-operative surgery measured time intervals (p value > 0.05). The overall pain relief among patients’ femoral nerve block group following TKR surgery was higher comparing with pain relief among non-femoral nerve block group after the surgery. There is a significant difference in post-operative surgery analgesia consumption between femoral nerve block and non-femoral nerve block. A Mann-Whitney test indicated that post-operative surgery analgesia consumption was greater for non-femoral nerve block group than femoral nerve block group (U = 66, Z score= -7.85, p = .001). The overall satisfaction of patients’ femoral nerve block group following TKR surgery was higher comparing with overall satisfaction of non-femoral nerve block group. Conclusion This study compared post-operative nausea vomiting and drowsiness pain scores, opioid consumption, and patient satisfaction between subjects who received femoral nerve block with non-femoral nerve block in total knee replacement. This study found the overall satisfaction with the function of their operation knee among patients’ femoral nerve block group following total knee replacement surgery was higher comparing with overall satisfaction with the function of their operation knee among non-femoral nerve block group after the surgery. And pain relief among patients’ femoral nerve block group following total knee replacement surgery was higher comparing with pain relief among non-femoral nerve block group after the surgery some trends in the data, do suggest efficacy in the use of a femoral nerve block for total knee replacement | en_US |
| dc.identifier.uri | https://hdl.handle.net/20.500.11888/17806 | |
| dc.publisher | An-Najah National University | en_US |
| dc.subject | Total Knee Replacement | en_US |
| dc.subject | Femoral Nerve Block | en_US |
| dc.subject | post-operative nausea and vomiting | en_US |
| dc.supervisor | Dr. Jamal Qaddumi, Dr. Nouraldin Almasry | en_US |
| dc.title | The Effect of Femoral Nerve Block on Opioid Consumption among Patient’s who Underwent Total Knee Replacement under Spinal Anesthesia | en_US |
| dc.type | Thesis | en_US |