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A. Raimundo, et al.: Bloqueio do Nervo Femoral na Artroplastia Total do Joelho
Vários autores consideraram a ropivacaína, 5. Choi P, Bhandhari M, Scott K, Douketis JD. Epidural analgesia for
utilizada no nosso estudo, o anestésico local de pain relief following hip or knee replacement. Cochrane Database
of Systemic Reviews. 2003;3:CD003071.
escolha para o BNF devido à sua reduzida car- 6. Nussenzveig TC. Apin management after total joint replacement and
diotoxicidade e bloqueio motor, quando compa- its impact on patient outcomes. AORN J. 1999;34:25-30.
rado com a bupivacaína 14,15 . 7. Paul JE, Arya A, Hurlburt L, et al. Femoral nerve block improves
Apesar da eficácia analgésica demonstrada analgesia outcomes after total knee arthroplasty. Anesthesiology.
2010;113:1144-62.
pelo BNF, alguns cirurgiões mostram-se apreen- 8. Ng HP, Cheong K, Lim A, et al. Intraoperative single-shot “3-in-1”
sivos com a fraqueza muscular prolongada do femoral nerve block with ropivacaine 0,25%, ropivacaine 0,5% or
quadricípite femoral, que ocorre em 2% dos do- bupivacaine 0,25% provides comparable 48-hr analgesia after uni-
lateral total knee replacement. Can J Anaesth. 2001;48:1102-8.
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entes . Esta complicação é importante, porque 9. Allen HW, Liu SS, Ware PD, et al. Peripheral nerve blocks improve
pode condicionar quedas, fracturas e atraso na analgesia after total knee replacement surgery. Anesth Analg.
1998;87:93-7.
deambulação. Os estudos realizados até agora 10. Wang H, Boctor B, Verner J. The effect of single-injection femoral
não demonstram um maior bloqueio motor nos nerve block on rehabilitation and length of hospital stay after total
doentes submetidos a BNF (versus PCA) . knee replacement. Reg Anesth Pain Med. 2002;27:139-44.
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Em conclusão, os autores consideram que o 11. Hunt KJ, Bourne MH, Mariani EM. Single-injection femoral and sci-
BNF assume-se como uma opção analgésica atic nerve blocks for pain control after total knee arthroplasty. J
Arthroplasty. 2009;24:533-8.
major para a ATJ, sendo necessários alguns es- 12. Ozen M, Iman N, Tumer F, et al. The effect of 3-in-1 femoral nerve
tudos adicionais para avaliação do verdadeiro block with ropivacaine 0,375% on posteoperative morphine con-
risco versus benefício desta técnica. sumption in elderly patients after total knee replacement surgery.
Agri. 2006;18:44-50.
13. Salinas FV, Liu SS, Mulroy MF. The effect of single-injection femoral
Bibliografia nerve block versus continuous femoral nerve block after total knee
arthroplasty on hospital length of stay and long-term functional re-
1. Fowler S, Symons J, Sabato S, et al. Epidural analgesia compared covery within a established clinical pathway. Anaesth Analg.
with peripheral nerve blockade after major knee surgery: a system- 2006;102:1234-9.
atic review and meta-analysis of randomized trials. British Journal 14. Ganapathy S, Wasserman RA, Watson JT, et al. Modified continuous
of Anaesthesia. 2008;100(2):154-64. femoral three-in-one block for postoperative pain after total knee
2. Rasanen P, Paavolainen P, Sintone H, et al. Efectiveness of hip or arthroplasty. Anesth Analg. 1999;89:1197-202.
knee replacement surgery in terms of quality-adjusted life years and 15. Ng HP, Cheong KF, Lim A, et al. Intra-operative single-shot ‘3-in-1’
costs. Acta Orthopaedica. 2007;78:108-15. femoral nerve block with ropivacaine 0,25%, ropivacaine 0,5% or
3. Puolakka PAE, Rorarius MGF, Raviola M, et al. Persistent pain fol- bupivacaine 0,25% provides comparable 48-hr analgesia after uni-
lowing Knee arthroplasty. Eur J Anaesthesiol. 2010;27:455-60. lateral total knee replacement. Can J Anaesth. 2001;48:1102-8.
4. Fisher H, Simanski C, Sharp C, et al. A procedure-specific system- 16. Kandasami M, Kinninmonth AW, Sarungi M, et al. Femoral nerve
atic review and consensus recommendations for postoperative analge- block for total knee replacement – a word of caution. Knee.
sia following total knee arthroplasty. Anaesthesia. 2008;63:1105-23. 2009;16:98-100.

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