Effect of Preemptive Femoral Nerve Block on Pain Control and Opioid Consumption After Total Knee Arthroplasty: A Randomized Controlled Trial

Aim: Peripheral nerve blocks, particularly femoral nerve blocks (FNBs), are a practical choice for relieving severe pain after total knee arthroplasty (TKA). We investigated the effectiveness of preemptive FNB on postoperative pain control and the reduction of opioid consumption. Methods: This was a single-center, prospective, randomized controlled trial conducted at a tertiary care health center, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Turkey. The study included 40 American Society of Anesthesiologists I-III patients scheduled for elective TKA surgery. Patients were studied in two groups. The FNB group (n=20) received preemptive single-injection FNB (15 mL of prilocaine 2% and 15 mL of 0.5% bupivacaine using a peripheral nerve stimulator) before general anesthesia (GA) as the study group and the control group (n=20) received standardized GA. The primary outcome measure was pain scores evaluated as numeric pain rating scale (0-10) at 2, 4, 8, 12, 16, 18, 20, and 24 h. Secondary outcome measures included opioid consumption with patient-controlled and perioperative hemodynamic changes. Results: Pain scores and opioid consumption in the FNB group were significantly lower than those in the control group at every measurement time (p<0.05). Total perioperative morphine use was also lower in the FNB group (p=0.023). Regarding hemodynamic variables, the heart rate values at the beginning of surgery and tourniquet insufflation in the FNB group were significantly lower than those in the control group. Conclusion: Using the FNB as part of any multimodal analgesia protocol to alleviate pain after TKA with less analgesic use would be beneficial

Predicting Mortality and Morbidity of Geriatric Femoral Fractures Using a Modified Frailty Index and Perioperative Features: A Prospective, Multicentre and Observational Study

Introduction: Femoral fracture is associated with high geriatric mortality. Frailty is the increased vulnerability to stressors resulting from aging-associated decreases in physiological reserve. We aimed to predict 30-365-day postoperative mortality and morbidity rates using modified frailty index and perioperative characteristics in geriatric femoral fractures. Materials and Method: Using a prospective observational design, data were collected from patients >65 years undergoing femoral fracture surgery from 13 different hospitals in 2016 and 2017. Post-discharge follow-up periods were 30, 90, 180, and 365 days. Age, sex, modified frailty index and anaesthesia types used during surgery were recorded. Renal markers, troponin I and haemoglobin levels were examined preoperatively and postoperatively at 24 and 72 hours. Results: We included 392 patients in this study. The age of the patients were between 65 and 101 (mean, 79 +/- 11.9). Median modified frailty index was 5 (interquartile range, 2-7). Increase in modified frailty index increased mortality rate. Mortality rate at postoperative 30 days was 9.8%, while overall study mortality rate was 23%. Spinal anaesthesia was administered in 205 patients (52.3%, most frequent), followed by general in 110 (28.1%), peripheral nerve blocks in 21 (5.4) and spinal-epidural in 43 (11%). Anaesthesia type affected both intensive care unit (p<0.001) and total hospitalization (p<0.012) duration. A logistic regression model revealed that frailty index, preoperative creatinine and centre type were independent mortality predictors. Conclusion: Increased modified frailty index was associated with higher postoperative mortality risk, thus providing an additional way for improving risk stratification. Preoperative creatinine increase and centre types are determining factors in mortality.WoSScopu