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Complications of Femoral Nerve Block for Total Knee Arthroplasty

  • Symposium: Papers Presented at the Annual Meetings of the Knee Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Preemptive and multimodal pain control protocols have been introduced to enhance rehabilitation after total knee arthroplasty (TKA). We determined the complication rate associated with preoperative femoral nerve block (FNB) for TKA. Among 1018 TKA operations, we performed 709 FNBs using a single-injection technique into the femoral nerve sheath and confirming position with nerve stimulation before induction. After TKA, weightbearing as tolerated was initiated using a walker or crutches on postoperative Day 1. Twelve patients (1.6%) treated with FNB sustained falls, three (0.4%) of whom underwent reoperations. Five patients had postoperative femoral neuritis, which may have been secondary to the block. One patient had new onset of atrial fibrillation after FNB, and the TKA was postponed. Femoral nerve block before TKA is not a harmless intervention. We recommend postoperative protocols be modified for patients who have FNB to account for decreased quadriceps function in the early postoperative period, which can lead to falls.

Level of Evidence: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank John Garfi for his help with the preparation of this article and John Tilzey, MD, and Michael Thompson, MD, for their contributions to this work.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Lahey Clinic Medical Center, 41 Mall Road, Burlington, MA, 01805, USA

    Sanjeev Sharma MD, FRCSC, Richard Iorio MD, Lawrence M. Specht MD, Sara Davies-Lepie MD & William L. Healy MD

Authors
  1. Sanjeev Sharma MD, FRCSC
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  2. Richard Iorio MD
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  3. Lawrence M. Specht MD
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  4. Sara Davies-Lepie MD
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  5. William L. Healy MD
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Corresponding author

Correspondence to Richard Iorio MD.

Additional information

Institutional research support was received from DePuy (Warsaw, IN). One author (WLH) is a designer surgeon/consultant for DePuy.

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Sharma, S., Iorio, R., Specht, L.M. et al. Complications of Femoral Nerve Block for Total Knee Arthroplasty. Clin Orthop Relat Res 468, 135–140 (2010). https://doi.org/10.1007/s11999-009-1025-1

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  • DOI: https://doi.org/10.1007/s11999-009-1025-1

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