| Comparison of Continuous Three-in-One Block and Intravenous Patient-Controlled Analgesia for Postoperative Pain after Total Knee Replacement. |
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Chang Kil Park, Jung Ha Cho, Choon Kyu Cho, Young Ju Kim |
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Department of Anesthesiology and Pain Medicine, Eulji University Hospital, Daejeon, Korea. pck@emc.eulji.ac.kr |
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| Abstract |
BACKGROUND
Severe postoperative pain can delay knee rehabilitation and prolong the duration of convalescence after a total knee replacement (TKR). This study compared a continuous 3-in-1 block using a patient-controlled analgesia (PCA) technique and IV PCA for analgesia after a unilateral TKR.
METHODS
Forty patients scheduled for an elective TKR under spinal anesthesia were randomly divided into two groups.
Group 1 received an IV PCA with butorphanol and ketorolac.
Group 2 received a continuous 3-in-1 block performed with 20 ml of 0.25% bupivacaine and epinephrine 1 : 200,000, followed by a continuous infusion of 0.125% bupivacaine through a femoral catheter at a rate of 2 ml/h plus 1 ml PCA boluses of a lockout time of 10 min. The level of pain was assessed at rest and during continuous passive motion using a visual analog scale (VAS). The VAS pain scores, nausea and vomiting were recorded in the postanesthetic care unit, at 6 PM on the day of operation, and at 8 AM and 6 PM on postoperative days 1 and 2, respectively. The duration of surgery, anesthesia time, blood loss, and hospital stay were compared.
RESULTS
The patients in Group 2 reported lower VAS pain scores than those in Group 1 (P < 0.05). The duration of surgery, nausea and vomiting, blood loss, and hospital stay were similar in the two groups except for the anesthesia time.
CONCLUSIONS
A continuous 3-in-1 block with a PCA technique provides better pain relief than IV PCA with butorphanol and ketorolac after TKR. |
| Key Words:
bupivacaine; continuous 3-in-1 block; patient-controlled analgesia; total knee replacement |
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