Postoperative analgesia after total knee replacement: the effect of an obturator nerve block added to the femoral 3-in-1 nerve block

Anesth Analg. 2004 Jul;99(1):251-4. doi: 10.1213/01.ane.0000121350.09915.84.


Femoral nerve block (FNB) does not consistently produce anesthesia of the obturator nerve. In this single-blind, randomized, controlled study we added a selective obturator nerve block (ONB) to FNB to analyze its influence on postoperative analgesia after total knee replacement (TKR). Before general anesthesia, 90 patients undergoing TKR received FNB (Group 1), FNB and selective ONB (Group 2), or placebo FNB (Group 3). Postoperative analgesia was further provided by morphine IV via patient-controlled analgesia. Analgesic efficacy and side effects were recorded in the first 6 h after surgery. Adductor strength decreased by 18% +/- 9% in Group 1 and by 78% +/- 22% in Group 2 (P < 0.0001). Total morphine consumption was reduced in Group 2 compared with Groups 1 and 3 (P < or = 0.0001). Patients in Group 2 reported lower pain scores than those in Groups 1 and 3 (P = 0.0003). The incidence of nausea was more frequent in Groups 1 and 3 (P = 0.01). We conclude that FNB does not produce complete anesthesia of the obturator nerve. Single-shot FNB does not provide additional benefits on pain at rest over opioids alone in the early postoperative period. The addition of an ONB to FNB improves postoperative analgesia after TKR.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Analgesia, Patient-Controlled
  • Analgesics, Opioid / administration & dosage
  • Analgesics, Opioid / therapeutic use
  • Arthroplasty, Replacement, Knee*
  • Female
  • Femoral Nerve*
  • Humans
  • Male
  • Morphine / administration & dosage
  • Morphine / therapeutic use
  • Nerve Block*
  • Obturator Nerve*
  • Pain Measurement
  • Pain, Postoperative / drug therapy*
  • Postoperative Nausea and Vomiting / epidemiology
  • Single-Blind Method


  • Analgesics, Opioid
  • Morphine