ABSTRACT
Background:
Adequate postoperative pain relief facilitates rapid recovery by enhancing early ambulation. The aim of the study was a comparison between the efficiency of Patient controlled analgesia via continuous fascia iliaca block and continuous epidural block in patients undergoing total knee replacement under Spinal anesthesia.
Patient and Methods:
A comparative prospective clinical trial was performed upon 48 patients undergoing total knee replacement randomly distributed into two equal groups: Continuous Fascia Iliaca Compartment block (CFICB) and Continuous epidural block (CEB). Two hours after spinal anesthesia, a bolus of 30ml and 10 ml of 0.25% bupivacaine were given in the first and second groups respectively; then patient-controlled analgesia (PCA) infuser was connected to perinural and epidural catheters and bupivacaine (0.125%) was infused for 48 hrs postoperatively at a rate of 5 ml/h, the bolus infusion volume was 2ml, and the lockout time was set to 15 minutes.


Results:
Statistically, the analgesic efficacy and the level of patient satisfaction in both groups were comparable. The mean blood pressure was significantly lower in CEB group in 1st hour after activation of the catheter, however no significant difference at other times. Nausea, vomiting and urine retention occurred exclusively in CEB group. Success in Rehabilitation and duration of hospital stay were comparable between groups.


Conclusion:
The efficiency of patient-controlled analgesia via CFICB was comparable with that via CEB for pain relief after total knee replacement. Only, CEB was associated with minimal side effects.