Efficacy and Side Effect Profile of Intrathecal Morphine versus Distal Femoral Triangle Nerve Block for Analgesia following Total Knee Arthroplasty: A Randomized Trial

(1) Background: The management of postoperative pain after knee replacement is an important clinical problem. The best results in the treatment of postoperative pain are obtained using multimodal therapy principles. Intrathecal morphine (ITM) and single-shot femoral nerve block (SSFNB) are practiced in the treatment of postoperative pain after knee replacement, with the most optimal methods still under debate. The aim of this study was to compare the analgesic efficacy with special consideration of selected side effects of both methods. (2) Materials and methods: Fifty-two consecutive patients undergoing knee arthroplasty surgery at the Department of Orthopedics and Traumatology of the Medical University of Warsaw were included in the study. Patients were randomly allocated to one of two groups. In the ITM group, 100 micrograms of intrathecal morphine were used, and in the SSFNB group, a femoral nerve block in the distal femoral triangle was used as postoperative analgesia. The other elements of anesthesia and surgery did not differ between the groups. (3) Results: The total dose of morphine administered in the postoperative period and the effectiveness of pain management did not differ significantly between the groups (cumulative median morphine dose in 24 h in the ITM group 31 mg vs. SSFNB group 29 mg). The incidence of nausea and pruritus in the postoperative period differed significantly in favor of patients treated with a femoral nerve block. (4) Conclusions: Although intrathecal administration of morphine is similarly effective in the treatment of pain after knee replacement surgery as a single femoral triangle nerve block, it is associated with a higher incidence of cumbersome side effects, primarily nausea and pruritus.

[1]  H. Kehlet,et al.  Pain management after total knee arthroplasty , 2022, European journal of anaesthesiology.

[2]  J. D. de Graaff,et al.  Serious Adverse Events after a Single Shot of Intrathecal Morphine: A Case Series and Systematic Review , 2022, Pain research & management.

[3]  B. Lee,et al.  Optimal location for continuous catheter analgesia among the femoral triangle, proximal, or distal adductor canal after total knee arthroplasty: a randomized double-blind controlled trial , 2022, Regional Anesthesia & Pain Medicine.

[4]  F. Agrò,et al.  The para‐sartorial compartments (PASC) block: a new approach to the femoral triangle block for complete analgesia of the anterior knee , 2022, Anaesthesia reports.

[5]  Longyun Li,et al.  A meta-analysis on advantages of peripheral nerve block post-total knee arthroplasty , 2021, The Korean journal of pain.

[6]  D. Hunter,et al.  Clinical Course of Pain and Function Following Total Knee Arthroplasty: A Systematic Review and Meta-Regression. , 2021, The Journal of arthroplasty.

[7]  J. Burch,et al.  For people post knee replacement surgery, how does femoral nerve block (FNB) compare with opioids, epidural, or local infiltration analgesia? , 2020 .

[8]  Bao-chang Qi,et al.  Comparison of intrathecal morphine versus local infiltration analgesia for pain control in total knee and hip arthroplasty , 2020, Medicine.

[9]  E. Pogatzki-Zahn,et al.  Pain therapy to reduce perioperative complications , 2019, Innovative surgical sciences.

[10]  M. Kapoor,et al.  A comparative analysis of femoral nerve block with adductor canal block following total knee arthroplasty: A systematic literature review , 2018, Journal of anaesthesiology, clinical pharmacology.

[11]  R. Owczuk,et al.  Postępowanie w bólu pooperacyjnym 2018 — stanowisko Sekcji Znieczulenia Regionalnego i Terapii Bólu Polskiego Towarzystwa Anestezjologii i Intensywnej Terapii, Polskiego Towarzystwa Znieczulenia Regionalnego i Leczenia Bólu, Polskiego Towarzystwa Badania Bólu oraz Konsultanta Krajowego w dziedzinie , 2018, Anestezjologia Intensywna Terapia.

[12]  J. Neal,et al.  Anesthesia and Analgesia Practice Pathway Options for Total Knee Arthroplasty: An Evidence-Based Review by the American and European Societies of Regional Anesthesia and Pain Medicine , 2017, Regional Anesthesia & Pain Medicine.

[13]  Zi-rong Li,et al.  Adductor Canal Block Versus Femoral Nerve Block for Analgesia After Total Knee Arthroplasty: A Systematic Review and Meta-analysis , 2017, The Clinical journal of pain.

[14]  Chun-Ming Huang,et al.  Intrathecal morphine verse femoral nerve block for pain control in total knee arthroplasty: A meta-analysis from randomized control trials. , 2016, International journal of surgery.

[15]  R. Brull,et al.  Is sciatic nerve block advantageous when combined with femoral nerve block for postoperative analgesia following total knee arthroplasty? a meta-analysis , 2016, Canadian Journal of Anesthesia/Journal canadien d'anesthésie.

[16]  Zhixia Chen,et al.  Analgesia for total knee arthroplasty: a meta-analysis comparing local infiltration and femoral nerve block , 2015, Clinics.

[17]  J. Theis,et al.  Femoral nerve infusion after primary total knee arthroplasty , 2015, Bone & joint research.

[18]  M. Fransen,et al.  Femoral nerve blocks for acute postoperative pain after knee replacement surgery. , 2014, The Cochrane database of systematic reviews.

[19]  P. Erwin,et al.  Falls and major orthopaedic surgery with peripheral nerve blockade: a systematic review and meta-analysis. , 2013, British journal of anaesthesia.

[20]  A. Blom,et al.  Acute postoperative pain at rest after hip and knee arthroplasty: severity, sensory qualities and impact on sleep. , 2011, Orthopaedics & traumatology, surgery & research : OTSR.

[21]  S. Kurtz,et al.  International survey of primary and revision total knee replacement , 2011, International Orthopaedics.

[22]  B. Ilfeld,et al.  The Association Between Lower Extremity Continuous Peripheral Nerve Blocks and Patient Falls After Knee and Hip Arthroplasty , 2010, Anesthesia and analgesia.

[23]  M. Antonelli,et al.  Post-operative analgesia following total knee arthroplasty: comparison of low-dose intrathecal morphine and single-shot ultrasound-guided femoral nerve block: a randomized, single blinded, controlled study. , 2010, European review for medical and pharmacological sciences.

[24]  M. Tryba,et al.  The effective duration of analgesia after intrathecal morphine in patients without additional opioid analgesia: a randomized double-blind multicentre study on orthopaedic patients , 2009, European journal of anaesthesiology.

[25]  M. Beach,et al.  A Single Injection Ultrasound-Assisted Femoral Nerve Block Provides Side Effect-Sparing Analgesia When Compared with Intrathecal Morphine in Patients Undergoing Total Knee Arthroplasty , 2004, Anesthesia and analgesia.

[26]  Richard Taylor,et al.  Intrathecal Morphine for Postoperative Analgesia: A Randomized, Controlled, Dose-Ranging Study After Hip and Knee Arthroplasty , 2003, Anesthesia and analgesia.

[27]  X. Capdevila,et al.  Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery. , 1999, Anesthesiology.