Continuous “three–in–one” Femoral Block for Analgesia after Unilateral Total Knee Replacement; the Value of Adding Verapamil

This study was designed to investigate the possible analgesic role of verapamil in the continuous 3–in–1femoral block after total knee replacement (TKR). Forty two patients scheduled for TKR were randomly assigned to one of two groups. Group “R” received 15 ml Ropivacaine 0.75 % and a bolus of 5 ml normal saline. Group “R–V” received 15 ml Ropivacaine 0.75 % and verapamil 2.5 mg diluted in 5 ml normal saline. General anesthesia was standardized for all study groups. After recovery: In group “R”, Ropivacaine 0.2 % was given in a rate of 5 ml ⁄ hr., whereas in group “R–V”, Ropivacaine 0.2 % mixed with verapamil was given at the same rate. Hemodynamic changes, intensity of resting and moving pain by VAS, consumption of systemic analgesia, amplitude of knee flexion, hospital stay and general or local adverse effects were assessed. Two cases were excluded due to complete failure. Both groups were comparable regarding the progress of sensory and motor block. The mean VAS scores were significantly lower (P<0.05) in group R–V than group R during rest and during physical therapy sessions. We concluded that the addition of verapamil potentiates the analgesic effect of Ropivacaine in 3–in–1 block without side effects. More studies are required to clarify dose–responses of verapamil.