Comparison of Extended-Release Epidural Morphine With Femoral Nerve Block to Patient-Controlled Epidural Analgesia for Postoperative Pain Control of Total Knee Arthroplasty: A Case-Controlled Study
Sugar, Scott L.; Hutson, Larry R., Jr.; Shannon, Patrick; Thomas, Leslie C.; Nossaman, Bobby D.
Background: Because newer anticoagulation strategies for total knee replacement present potentially increased risk of neuraxial analgesia, there is movement away from using patient-controlled epidural analgesia (PCEA) for pain control. This concern opens the door for other regional modalities in postoperative analgesia, including the use of extended-release epidural morphine (EREM) combined with a femoral nerve block (FNB).; Methods: This study was a prospective observational chart review with the use of recent historical controls in patients undergoing unilateral total knee replacement. Outcomes of interest were 0-, 24-, and 48-hour postoperative pain scores using the visual analog scale (VAS); incidence of side effects; and time spent in the postanesthesia care unit (PACU).; Results: Postoperative pain scores at 24 and 48 hours in the EREM and FNB group (n = 14; 2.6 +/- 0.6 and 5.0 +/- 0.9, respectively) were comparable to the PCEA group (n = 14; 3.8 +/- 0.6 and 4.2 +/- 0.9). The PACU time was shorter in the EREM and FNB group (2.4 +/- 0.3 hours) compared with PCEA 3.6 +/- 0.3 hours, P =.02). No statistically significant difference was found in the incidence of side effects between the 2 groups.; Conclusions: The VAS scores at 24 and 48 hours indicate that EREM and FNB provide comparable analgesia to PCEA. The trend toward shorter PACU times represents an opportunity for costidentification analysis. The study data are limited by their observational nature and the small number of patients involved; nevertheless, this study demonstrates a therapeutic equivalence to PCEA that may be more cost effective.