Femoral Nerve Block and Total Knee Arthroplasty

It is likely that the popularity of FNB use in patients with total knee arthroplasty can be attributed to its provision of effective analgesia, facilitation of physical therapy and reducing the length of stay in hospital. The length of hospital stay would be a major determinant of the effectiveness of FNB.
             Problem Statement.
             Widmer et al. (2013) acknowledge total knee arthroplasty (TKA) as an increasingly common major surgical procedure, whose popularity is likely to continue rising in tandem with rising patient longevity and expanding indications. Tanikawa et al. (2014) observes that TKA is responsible for generating severe postoperative pain in approximately 60 percent of patients and moderate pain in 30 percent of patients, and pain is considered to impede early intensive rehabilitation. Femoral nerve block (FNB) has emerged an effective alternative to consider in treating postoperative pain. However, Guirro, Tambara, and Munhoz (2013) notes that there remains no consensus about the most appropriate technique postoperative pain control of anterior cruciate ligament reconstruction. Nevertheless, the attractiveness of FNB is evident from its rise in acceptance, which results from studies suggesting that the technique offers better pain control and has fewer side effects in comparison to other modalities (Shum et al., 2009). .
             Theoretically, it is assumed that the extended postoperative analgesia with few side effects, which have come to characterize FNB, is linked with facilitating faster rehabilitation and consequently permitting early ambulation and reducing the length of hospitalization. However, Tanikawa et al. (2014) finds that even though FNB is widely accepted and commonly applied technique, there are studies that have established that some patients undergo significant postoperative pain despite using FNB. Furthermore, Shah and Jain (2014) acknowledge the studies showing FNB as responsible in reducing the strength of the quadriceps muscle and association of peripheral nerve blocks with increased risk of falling.