Ambulatory continuous femoral nerve blocks decrease time to discharge readiness after tricompartment total knee...

Area of Science:

• Anesthesiology
• Orthopedic Surgery
• Pain Management

Background:

• Continuous femoral nerve blocks (cFNB) are used for pain management after total knee arthroplasty (TKA).
• The optimal duration of cFNB for enhancing patient recovery and discharge readiness remains under investigation.
• This study compares overnight cFNB with a 4-day ambulatory cFNB following tricompartment TKA.

Purpose of the Study:

• To evaluate if a 4-day ambulatory cFNB improves ambulation distance post-TKA compared to an overnight cFNB.
• To determine if a 4-day ambulatory cFNB reduces the time to meet key discharge criteria after TKA.

Main Methods:

• Patients (n=50) received an overnight cFNB with ropivacaine.
• Postoperatively, patients were randomized to continue ropivacaine or switch to saline for the cFNB.
• Primary outcomes included time to meet discharge criteria (analgesia, no IV pain meds, 30m ambulation) and 6-minute walk distance.

Main Results:

• The 4-day ropivacaine group met discharge criteria significantly faster (median 25h vs. 71h, P < 0.001).
• Patients receiving 4-day ropivacaine ambulated a median of 32m, compared to 26m in the control group (P = 0.42).
• The extended infusion demonstrated a 53% reduction in time to meet discharge criteria.

Conclusions:

• A 4-day ambulatory cFNB significantly accelerates the time to meet discharge readiness criteria after TKA.
• Extended cFNB infusion did not significantly increase ambulation distance on the afternoon after surgery.
• Ambulatory cFNB offers a potential benefit in early recovery for TKA patients.