Health-Related Quality of Life After Tricompartment Knee Arthroplasty With and Without an Extended-Duration Continuous Femoral Nerve Block: A Prospective, One-Year Follow-Up of a Randomized, Triple-Masked, Placebo-Controlled Study
Brian M. Ilfeld, MD, MS, Associate Professor,1 R. Scott Meyer, MD, Associate Clinical Professor,2 Linda T. Le, MD, Assistant Professor,3 Edward R. Mariano, MD, Assistant Clinical Professor,4 Brian A. Williams, MD, MBA, Associate Professor,5 Krista Vandenborne, PhD, PT, Associate Professor and Chair,6 Pamela W. Duncan, PhD, PT, Professor,7 Daniel I. Sessler, MD, Professor and Chair,8 F. Kayser Enneking, MD, Professor and Chair,9 Jonathan J. Shuster, PhD, Research Professor,10 Rosalita C. Maldonado, BS, Research Coordinator,11 and Peter F. Gearen, MD, Associate Professor and Chair12Knee
Background
We previously provided evidence that extending an overnight continuous femoral nerve block to 4 days after tricompartment knee arthroplasty (TKA) provides clear benefits during the perineural infusion in the immediate postoperative period. However, it remains unknown if the extended infusion improves subsequent health-related quality of life between 7 days and 12 months.
Methods
Patients undergoing TKA received a femoral perineural infusion of ropivacaine 0.2% from surgery until the following morning, at which time patients were randomized to either continue perineural ropivacaine (n=25) or normal saline (n=25) in a double-masked fashion. Patients were discharged with their catheter and a portable infusion pump, and catheters were removed on postoperative day 4. Health-related quality of life was measured using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index preoperatively and then at 7 days, as well as 1, 2, 3, 6, and 12 months after surgery. The WOMAC evaluates 3 dimensions of health-related quality of life: pain, stiffness and physical functional disability. For inclusion in the analysis, we required a minimum of 4 of the 6 time points, including day 7 and at least 2 of months 3, 6 and 12.
Results
The 2 treatment groups had similar WOMAC scores for the mean area under the curve calculations (point estimate for the difference in mean area under the curve for the 2 groups [overnight infusion group − extended infusion group]=1.2, 95% confidence interval: −5.6 to +8.0; p=0.72) and at all individual time points (p>0.05).
Conclusions
We found no evidence that extending an overnight continuous femoral nerve block to 4 days improves (or worsens) subsequent health-related quality of life between 7 days and 12 months after TKA. (ClinicalTrials.gov number, NCT00135889.)
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