A multicenter, randomized, triple-masked, placebo-controlled trial of the effect of ambulatory continuous femoral nerve blocks on discharge-readiness following total knee arthroplasty in patients on general orthopaedic wards

A continuous femoral nerve block (cFNB) involves the percutaneous insertion of a catheter adjacent to the femoral nerve, followed by a local anesthetic infusion, improving analgesia following total knee arthroplasty (TKA). Portable infusion pumps allow infusion continuation following hospital discharge, raising the possibility of decreasing hospitalization duration. We therefore used a multicenter, randomized, triple-masked, placebo-controlled study design to test the primary hypothesis that a 4-day ambulatory cFNB decreases the time until each of three predefined readiness-for-discharge criteria (adequate analgesia, independence from intravenous opioids, and ambulation >= 30 m) are met following TKA compared with an overnight inpatient-only cFNB. Preoperatively, all patients received a cFNB with perineural ropivacaine 0.2% from surgery until the following morning, at which time they were randomized to either continue perineural ropivacaine (n = 39) or switch to normal saline (n = 38). Patients were discharged with their cFNB and portable infusion pump as early as postoperative day 3. Patients given 4 days of perineural ropivacaine attained all three criteria in a median (25th-75th percentiles) of 47 (29-69) h, compared with 62 (45-79) h for those of the control group (Estimated ratio = 0.80, 95% confidence interval: 0.66-1.00; p = 0.028). Compared with controls, patients randomized to ropivacaine met the discharge criterion for analgesia in 20 (0-38) versus 38 (15-64) h (p = 0.009), and intravenous opioid independence in 21 (0-37) versus 33 (11-50) h (p = 0.061). We conclude that a 4-day ambulatory cFNB decreases the time to reach three important discharge criteria by an estimated 20% following TKA compared with an overnight cFNB, primarily by improving analgesia. (C) 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.