Abstract
Ambulation in the early postoperative period of total knee arthroplasty is crucial, in order to avoid complications and obtain preferable outcomes. Although a femoral nerve block can provide enough postoperative analgesia after total knee arthroplasty, falling, or other accidents due to motor paresis, are potentially adverse events in patients who have received a conventional femoral nerve block. We devised a modified femoral nerve block to spare voluntary knee extension ability, and clinically applied it to patients who received total knee arthroplasty under minimally invasive surgery. In our new-approach nerve blockade technique, the main targets of the sensory nerves are the saphenous nerves which branch out from the femoral nerve trunk. All the patients rated pain at bed rest between 0 and 3 on a numerical rating scale 3 h after the operation. In addition, the rectus femoris muscle was not affected at all, and the surgically invaded vastus medialis oblique muscle was completely anesthetized. Patients were able to not only actively raise their extremities with their knee in extension, but also to flex the knee in the air without pain or aggravation. On day 0, the patients were able to walk around, with the leg that had been operated upon not giving way. Our anesthetic approach can provide better pain relief than a conventional femoral nerve block, while the patients achieve ambulation on the day of the procedure, following minimally invasive knee surgery.
References
Floren M, Reichel H, Davis J, Laskin RS. The mini-incision mid-vastus approach for total knee arthroplasty. Oper Orthop Traumatol. 2008;20:534–43.
Hitos K, Fletcher JP. Venous thromboembolism following primary total knee arthroplasty. Int Angiol. 2006;25:343–51.
Anns JP, Chen EW, Nirkavan N, McCartney CJ, Awad IT. A comparison of sartorius versus quadriceps stimulation for femoral nerve block: a prospective randomized double-blind controlled trial. Anesth Analg. 2011;112:725–31.
Brull R, Prasad GA, Gandhi R, Ramlogan R, Khan M, Chan VW. Is a patella motor response necessary for continuous femoral nerve blockade performed in conjunction with ultrasound guidance? Anesth Analg. 2011;112:982–6.
Fukuda A, Hasegawa M, Kato K, Shi D, Sudo A, Uchida A. Effect of tourniquet application on deep vein thrombosis after total knee arthroplasty. Arch Orthop Trauma Surg. 2007;127:671–5.
Nakao S, Takata S, Uemura H, Nakano S, Egawa H, Kawasaki Y, Kashihara M, Yasui N. Early ambulation after total knee arthroplasty prevents patients with osteoarthritis and rheumatoid arthritis from developing postoperative higher levels of D-dimer. J Med Invest. 2010;57:146–51.
Ilfeld BM, Duke KB, Donohue MC. The association between lower extremity continuous peripheral nerve blocks and patient falls after knee and hip arthroplasty. Anesth Analg. 2010;111:1552–4.
Manske PR, Gleeson P. Rehabilitation program following polycentric total knee arthroplasty. Phys Ther. 1977;57:915–8.
Sung DH, Jung JY, Kim HD, Ha BJ, Ko YJ. Motor branch of the rectus femoris: anatomic location for selective motor branch block in stiff-legged gait. Arch Phys Med Rehabil. 2003;84:1028–31.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Ishiguro, S., Asano, N., Yoshida, K. et al. Day zero ambulation under modified femoral nerve block after minimally invasive surgery for total knee arthroplasty: preliminary report. J Anesth 27, 132–134 (2013). https://doi.org/10.1007/s00540-012-1479-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00540-012-1479-2