femoral block or epidural TKR

jwk · Mar 21, 2008

Hey what do you prefer for post op pain control for TKR, epidural or femoral block? I prefer the FNB it allows a bit more mobility for the patient overnight with no cath to pull, calls from staff about the epidural, plus I think it is a bit faster to place. What does anybody think?

We seem to be moving decidedly towards the blocks and away from epidurals, although for us they actually take longer to place because we do so many epidurals.

stanman1968 · Mar 21, 2008

Really? I find I can place a femoral block in about 5 min or less and I can do it while patient is asllep after surgery or just before induction, with less patient cooperation. the epidural usually takes about 10 min to place with test dose tape etc. etc.

jwk · Mar 21, 2008

Really? I find I can place a femoral block in about 5 min or less and I can do it while patient is asllep after surgery or just before induction, with less patient cooperation. the epidural usually takes about 10 min to place with test dose tape etc. etc.

We just do so many darn epidurals - it's what we're used to, and change is sometimes slow in coming. It takes 5 min just to play around with the US machine.

stanman1968 · Mar 21, 2008

You use US? For all of your blocks? I have not had the privilage of using us yet. Do you find it that much more useful in normal patients vs the nerve stimulator? I see it in patients with abnormal body habitus but everyone?

zrmorgan · Mar 29, 2008

You use US? For all of your blocks? I have not had the privilage of using us yet. Do you find it that much more useful in normal patients vs the nerve stimulator? I see it in patients with abnormal body habitus but everyone?

I have been using the U/S on femoral nerve blocks...it does not take me any longer to do the block...in fact, it may reduce the time to do the block as I can see where I am putting the needle instead of searching for the twitch or feeling for the femoral, but the machine can be a little cumbersome to roll around in an OR already set up with tons of ortho equipment. Our U/S machine is a laptop, but I am worried it will fall off something if I take it off its rolling stand.

There is no doubt in my mind the U/S is a safer and quicker technique for interscalene blocks.

Our hospital was game on the U/S machine as they could bill additional anesthesia units for the procedure, and charge a facility fee as well. That covers the cost of the equipment if anyone is considering proposing a purchase for their practice.