Anesthesia of the anterior femoral cutaneous nerves for total knee arthroplasty incision: Randomized volunteer trial

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Anesthesia of the anterior femoral cutaneous nerves for total knee arthroplasty incision : Randomized volunteer trial. / Bjørn, Siska; Nielsen, Thomas Dahl; Moriggl, Bernhard; Hoermann, Romed; Bendtsen, Thomas Fichtner.

I: Regional Anesthesia and Pain Medicine, Bind 45, Nr. 2, 01.02.2020, s. 107-116.

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

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@article{314615fc13d0436984e31c934d120b4b,
title = "Anesthesia of the anterior femoral cutaneous nerves for total knee arthroplasty incision: Randomized volunteer trial",
abstract = "Background and objectives For pain relief after total knee arthroplasty (TKA), an injection at the midthigh level may produce analgesia inferior to that of a femoral nerve block as the anterior femoral cutaneous nerves (intermediate femoral cutaneous nerve (IFCN) and medial femoral cutaneous nerve (MFCN)) are not anesthetized. The IFCN can be selectively anesthetized in the subcutaneous tissue above the sartorius muscle and the MFCN by an injection in the proximal part of the femoral triangle (FT). The primary aim was to investigate the area of cutaneous anesthesia in relation to the surgical incision for TKA and anteromedial knee area after intermediate femoral cutaneous nerve blockade (IFCNB) in combination with an injection in the proximal or distal part of the FT (proximal vs distal femoral triangle block (FTB)). Methods The study was carried out as two separate investigations: First, dissection of nine cadaver sides to verify a technique for IFCNB; second, a volunteer study with 40 healthy volunteers. The surgical midline incision for TKA was drawn bilaterally. All volunteers received an active distal FTB combined with a placebo proximal FTB on one side and vice versa on the other side. All volunteers were randomized to an active IFCNB on one side and placebo IFCNB on the contralateral side. Results Identification of IFCN was successful in all cadaver sides. Fifteen out of 20 volunteers had complete anesthesia of the incision line after IFCNB combined with proximal FTB, which was significantly higher compared with proximal FTB alone and with distal FTB+IFCNB. A gap at the anteromedial knee area was present in 2/20 volunteers with proximal FTB compared with 17/20 with distal FTB when all volunteers had active IFCNB. Conclusion Ultrasound-guided blockade of the IFCN and MFCN anesthetize the surgical midline incision and the anteromedial area of the knee relevant for TKA. In contrast, an injection at the midthigh level produces insufficient cutaneous anesthesia not covering the areas of interest.",
keywords = "lower extremity, postoperative pain, regional anesthesia",
author = "Siska Bj{\o}rn and Nielsen, {Thomas Dahl} and Bernhard Moriggl and Romed Hoermann and Bendtsen, {Thomas Fichtner}",
year = "2020",
month = feb,
day = "1",
doi = "10.1136/rapm-2019-100904",
language = "English",
volume = "45",
pages = "107--116",
journal = "Regional Anesthesia and Pain Medicine",
issn = "1098-7339",
publisher = "LIPPINCOTT WILLIAMS & WILKINS",
number = "2",

}

RIS

TY - JOUR

T1 - Anesthesia of the anterior femoral cutaneous nerves for total knee arthroplasty incision

T2 - Randomized volunteer trial

AU - Bjørn, Siska

AU - Nielsen, Thomas Dahl

AU - Moriggl, Bernhard

AU - Hoermann, Romed

AU - Bendtsen, Thomas Fichtner

PY - 2020/2/1

Y1 - 2020/2/1

N2 - Background and objectives For pain relief after total knee arthroplasty (TKA), an injection at the midthigh level may produce analgesia inferior to that of a femoral nerve block as the anterior femoral cutaneous nerves (intermediate femoral cutaneous nerve (IFCN) and medial femoral cutaneous nerve (MFCN)) are not anesthetized. The IFCN can be selectively anesthetized in the subcutaneous tissue above the sartorius muscle and the MFCN by an injection in the proximal part of the femoral triangle (FT). The primary aim was to investigate the area of cutaneous anesthesia in relation to the surgical incision for TKA and anteromedial knee area after intermediate femoral cutaneous nerve blockade (IFCNB) in combination with an injection in the proximal or distal part of the FT (proximal vs distal femoral triangle block (FTB)). Methods The study was carried out as two separate investigations: First, dissection of nine cadaver sides to verify a technique for IFCNB; second, a volunteer study with 40 healthy volunteers. The surgical midline incision for TKA was drawn bilaterally. All volunteers received an active distal FTB combined with a placebo proximal FTB on one side and vice versa on the other side. All volunteers were randomized to an active IFCNB on one side and placebo IFCNB on the contralateral side. Results Identification of IFCN was successful in all cadaver sides. Fifteen out of 20 volunteers had complete anesthesia of the incision line after IFCNB combined with proximal FTB, which was significantly higher compared with proximal FTB alone and with distal FTB+IFCNB. A gap at the anteromedial knee area was present in 2/20 volunteers with proximal FTB compared with 17/20 with distal FTB when all volunteers had active IFCNB. Conclusion Ultrasound-guided blockade of the IFCN and MFCN anesthetize the surgical midline incision and the anteromedial area of the knee relevant for TKA. In contrast, an injection at the midthigh level produces insufficient cutaneous anesthesia not covering the areas of interest.

AB - Background and objectives For pain relief after total knee arthroplasty (TKA), an injection at the midthigh level may produce analgesia inferior to that of a femoral nerve block as the anterior femoral cutaneous nerves (intermediate femoral cutaneous nerve (IFCN) and medial femoral cutaneous nerve (MFCN)) are not anesthetized. The IFCN can be selectively anesthetized in the subcutaneous tissue above the sartorius muscle and the MFCN by an injection in the proximal part of the femoral triangle (FT). The primary aim was to investigate the area of cutaneous anesthesia in relation to the surgical incision for TKA and anteromedial knee area after intermediate femoral cutaneous nerve blockade (IFCNB) in combination with an injection in the proximal or distal part of the FT (proximal vs distal femoral triangle block (FTB)). Methods The study was carried out as two separate investigations: First, dissection of nine cadaver sides to verify a technique for IFCNB; second, a volunteer study with 40 healthy volunteers. The surgical midline incision for TKA was drawn bilaterally. All volunteers received an active distal FTB combined with a placebo proximal FTB on one side and vice versa on the other side. All volunteers were randomized to an active IFCNB on one side and placebo IFCNB on the contralateral side. Results Identification of IFCN was successful in all cadaver sides. Fifteen out of 20 volunteers had complete anesthesia of the incision line after IFCNB combined with proximal FTB, which was significantly higher compared with proximal FTB alone and with distal FTB+IFCNB. A gap at the anteromedial knee area was present in 2/20 volunteers with proximal FTB compared with 17/20 with distal FTB when all volunteers had active IFCNB. Conclusion Ultrasound-guided blockade of the IFCN and MFCN anesthetize the surgical midline incision and the anteromedial area of the knee relevant for TKA. In contrast, an injection at the midthigh level produces insufficient cutaneous anesthesia not covering the areas of interest.

KW - lower extremity

KW - postoperative pain

KW - regional anesthesia

UR - http://www.scopus.com/inward/record.url?scp=85076396751&partnerID=8YFLogxK

U2 - 10.1136/rapm-2019-100904

DO - 10.1136/rapm-2019-100904

M3 - Journal article

C2 - 31826920

AN - SCOPUS:85076396751

VL - 45

SP - 107

EP - 116

JO - Regional Anesthesia and Pain Medicine

JF - Regional Anesthesia and Pain Medicine

SN - 1098-7339

IS - 2

ER -