Comparative Study of Continuous Epidural Analgesia, Femoral Nerve Block and Patient Controlled Analgesia for Postoperative Analgesia Following Knee Surgery

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Background: Postoperative pain is insufficiently managed, despite significant advancements in the understanding of pain mechanisms and therapy. Aim: To compare the effect of continuous epidural analgesia, femoral nerve block, and patient-controlled analgesia for postoperative analgesia following a knee operation. Patients and methods: This randomized controlled single -blind investigation has been performed on 90 cases who were selected from the attendee of out-patient Anesthesiology, Intensive Care and Pain Management Clinics of Al-Azhar University Hospitals from November 2023 to august 2024. Results: An insignificant distinction in VAS levels has been observed among the three groups at most time points; however, Group E had significantly reduced VAS scores than Group F and Group P at 6 and 12 hours, respectively (p<0.05). Similarly, while mean arterial pressure showed insignificant variation among the groups at baseline, 0h, 1h, 24h, 36h, and 48h, Group E had significantly reduced values compared to Group F and Group P at 6 and 12 hours (p<0.05). Postoperative nausea and vomiting (PONV) and pruritus were comparable among groups, and no cases of hypoventilation were observed (p>0.05). Notably, patient satisfaction was significantly greater in Group E than in the other groups (p=0.009). Conclusion: Continuous epidural analgesia offers superior pain relief and hemodynamics than continuous femoral nerve block and patient-controlled analgesia following knee surgery. It also reduces total opioid consumption, improves patient satisfaction, and is less invasive than a continuous femoral nerve block.

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