Comparison of Continuous Three-in-One Block and Intravenous Patient-Controlled Analgesia for Postoperative Pain after Total Knee Replacement

Background: Severe postoperative pain can delay knee rehabilitation and prolong the duration of convalescence after a total knee replacement (TKR).This study compared a continuous 3-in-1 block using a patient-controlled analgesia (PCA) technique and IV PCA for analgesia after a unilateral TKR.Methods: Forty patients scheduled for an elective TKR under spinal anesthesia were randomly divided into two groups.Group 1 received an IV PCA with butorphanol and ketorolac.Group 2 received a continuous 3-in-1 block performed with 20 ml of 0.25% bupivacaine and epinephrine 1：200,000, followed by a continuous infusion of 0.125% bupivacaine through a femoral catheter at a rate of 2 ml/h plus 1 ml PCA boluses of a lockout time of 10 min.The level of pain was assessed at rest and during continuous passive motion using a visual analog scale (VAS).The VAS pain scores, nausea and vomiting were recorded in the postanesthetic care unit, at 6 PM on the day of operation, and at 8 AM and 6 PM on postoperative days 1 and 2, respectively.The duration of surgery, anesthesia time, blood loss, and hospital stay were compared.Results: The patients in Group 2 reported lower VAS pain scores than those in Group 1 (P ＜ 0.05).The duration of surgery, nausea and vomiting, blood loss, and hospital stay were similar in the two groups except for the anesthesia time.Conclusions: A continuous 3-in-1 block with a PCA technique provides better pain relief than IV PCA with butorphanol and ketorolac after TKR.(Korean J Anesthesiol 2006; 51: 76∼81) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ