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Effect of adding fentanyl to bupivacaine in femoral nerve block for post-operative pain in patient subjected to total knee replacement guided by ultrasound  


Journal of Anesthesia & Critical Care: Open Access
Alaa Ali M Elzohry, Khalid M Morsy, Fatma Gad-Elrab Askar, Abdelrahman M Abdelhafeez

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Abstract

Background: Total knee replacements surgeries are very important to improve mobility and quality of life and usually associated with sever postoperative pain. Femoral nerve block has been studied to improve post-operative pain. Adding adjuvant to local anesthesia (LA) as fentanyl in femoral nerve block could be a method to prolong the duration of the block. The aim of the study was to study the analgesic efficacy fentanyl added to bupivacaine in ultrasound guided femoral nerve block for patients undergoing elective total knee replacements surgeries. Methods: sixty patients (ASA I-II) of either sex were scheduled for elective total knee replacements surgeries. Patients were randomly allocated into two groups (30 patients each), to receive ultrasound guided femoral nerve block using; 18 ml bupivicaine 0.25% plus 2 ml normal saline (Group B) versus 18 ml bupivicaine 0.25% plus fentanyl 1 mic (ug)/ kg in 2 ml volume (Group BF). Postoperative pain was assessed over 24 hours using VAS scale plus time of first analgesic request and overall post-operative analgesics consumption were recorded. The intra and post-operative HR, SBP, DBP and MAP were recorded. Any concomitant complications were observed postoperatively. Results: As regard patient demographic data and ASA grades, we found there were no significant changes between the two groups, as shown in. Patient hemodynamic parameters either intra or post-operative, were comparable in both groups (P. value 0.19). There was a significant decrease in VAS pain scores in group LF during first day postoperative (P. value 0.00I*) and post-operative analgesic consumption much more decreased in group LF in comparison to group F (P. value 0.001*). We found that the time of the 1st request of analgesia in group L was (5.13±1.008) hours while it was (11.27±0.9), hours in group LF after end of operation, the difference between the two group was significant (p<0.001). Conclusion: Ultrasound guided FNB improve post-operative analgesia and the addition of fentanyl to bupivicaine in femoral nerve block prolonged the duration of block and decreased analgesic requirements in patient subjected to total knee replacement surgery.

Keywords

fentanyl, bupivacaine, femoral nerve block, acute post-operative pain, total knee replacement,VAS score

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