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Korean Journal of Anesthesiology 2006;51(1):76-81.
DOI: https://doi.org/10.4097/kjae.2006.51.1.76   
Comparison of Continuous Three-in-One Block and Intravenous Patient-Controlled Analgesia for Postoperative Pain after Total Knee Replacement.
Chang Kil Park, Jung Ha Cho, Choon Kyu Cho, Young Ju Kim
Department of Anesthesiology and Pain Medicine, Eulji University Hospital, Daejeon, Korea. pck@emc.eulji.ac.kr
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.
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.
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.
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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