Continuous femoral nerve block as pain management following total knee arthroplasty: a systematic review.

Migliorini, Filippo; Pappalardo, Gaetano; Bardazzi, Tommaso; Maffulli, Nicola; Bertini, Francesca Alzira; Simeone, Francesco; Vaishya, Raju; Memminger, Michael Kurt

Abstract

The present systematic review evaluated the current level of I evidence on continuous femoral nerve block (FNB) as pain management following total knee arthroplasty (TKA), comparing different drugs. This study followed the 2020 PRISMA guidelines. PubMed, Embase and Web of Science were accessed in November 2024. All clinical studies concerning continuous FNB for pain management following TKA were considered. Data from 22 RCTs were retrieved. The drugs included in the analyses were levobupivacaine, bupivacaine and ropivacaine in isolation or combined with prilocaine or dexmedetomidine. A statistically significant difference was found in VAS at rest in postoperative day (POD) 0 (p < 0.01): the bupivacaine group demonstrated the highest values, and the ropivacaine combined with dexmedetomidine group had the lowest values. No other statistically significant difference in VAS at rest was found for any group in POD 1, 2, and 3 (p = 0.1, p = 0.1, and p = 0.4, respectively). The groups receiving ropivacaine combined with dexmedetomidine and prilocaine had the lowest values of VAS during activity in POD2 (p < 0.01), while in POD3 the groups receiving ropivacaine combined with prilocaine and the bupivacaine one had the lowest values (p < 0.01). No significant difference was found in VAS during activity between any group in POD 0 (p = 0.4) and POD 1 (p = 0.3). Ropivacaine combined with dexmedetomidine might be the best compound for continuous femoral nerve block to manage pain following TKA during the first PODs. Further high-quality investigations are necessary to validate these findings in clinical settings. [Abstract copyright: © 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.]

Citation

Migliorini, F., Pappalardo, G., Bardazzi, T., Maffulli, N., Bertini, F. A., Simeone, F., Vaishya, R., & Memminger, M. K. (2025). Continuous femoral nerve block as pain management following total knee arthroplasty: a systematic review. Archives of Orthopaedic and Trauma Surgery, 145(1), Article 238. https://doi.org/10.1007/s00402-025-05855-3

• Journal Article Type: Article
• Acceptance Date: Mar 28, 2025
• Online Publication Date: Apr 11, 2025
• Publication Date: Apr 11, 2025
• Deposit Date: Apr 29, 2025
• Journal: Archives of orthopaedic and trauma surgery
• Print ISSN: 0936-8051
• Electronic ISSN: 1434-3916
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 145
• Issue: 1
• Article Number: 238
• DOI: https://doi.org/10.1007/s00402-025-05855-3
• Keywords: Management, Nerve Block - methods, Pain, Postoperative - therapy - prevention & control, Ropivacaine - administration & dosage, Dexmedetomidine - administration & dosage, Arthroplasty, Replacement, Knee - adverse effects, Femoral Nerve, Femoral nerve block, Arthroplasty, Anesthetics, Local - administration & dosage, Knee, Humans, Pain, Pain Management - methods, Bupivacaine - administration & dosage
• Public URL: https://keele-repository.worktribe.com/output/1200213
• Publisher URL: https://link.springer.com/article/10.1007/s00402-025-05855-3