Continuous femoral nerve blockade and single-shot sciatic nerve block promotes better analgesia and lower bleeding for total knee arthroplasty compared to intrathecal morphine: a randomized trial

Nora Elizabeth Rojas Álvarez,Adilson Hamaji,Marcelo Waldir Mian Hamaji,Joaquim Edson Vieira,Rosemberg Jairo Gomez Ledesma

doi:10.1186/s12871-017-0355-x

Nora Elizabeth Rojas Álvarez, Adilson Hamaji + Show 3 more

Open Access

https://doi.org/10.1186/s12871-017-0355-x

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Abstract

BackgroundKnee arthroplasty leads to postoperative pain. This study compares analgesia and postoperative bleeding achieved by intrathecal morphine with a continuous femoral plus single-shot sciatic nerve block.MethodsA randomized non-blinded clinical trial enrolled patients aged over 18 years old, ASA I to III who underwent total knee arthroplasty. All patients underwent spinal anesthesia with isobaric bupivacaine, 20 mg. One group received 100 mcg of intrathecal morphine (M group), and the other received a femoral nerve block by continuous infusion plus a "single shot" block of the sciatic nerve at the end of the surgery (FI group). Pain score from verbal numeric rating scale (VNRS) and morphine consumption during the first 72 h, as well as motor blockade, adverse effects, and postoperative bleeding were recorded. Analysis of variance of repeated measures with Bonferroni post-test, t-test and Fisher exact test were used for statistical analysis.ResultsThirty nine patients completed the study (M = 20; FI = 19 patients) and were similar except for higher age in the FI group. Motor blockade as well as movement pain during postanesthesia care unit (PACU) staying were not different between the groups, but movement pain was significantly lower in FI group after 24 h. Postoperative bleeding (ml) was lower in FI group.ConclusionsContinuous femoral nerve block combined with sciatic nerve block provides effective for postoperative analgesia in patients undergoing total knee arthroplasty, with lower pain scores after 24 h and a lower incidence of adverse effects and bleeding compared to intrathecal morphine.Trial registrationRetrospectively registered on https://clinicaltrials.gov/ under identifier NCT02882152, 23rd December, 2016.

Highlights

IntroductionThis study compares analgesia and postoperative bleeding achieved by intrathecal morphine with a continuous femoral plus single-shot sciatic nerve block
After the signing of the informed consent, forty patients aged over 18 years old, ASA physical status from I to III (American Society of Anesthesiologists) who underwent total knee arthroplasty (TKA) were included and allocated by means of a random number table
The patients were allocated into two groups: to receive 100 mcg of intrathecal morphine (Cristalia, São Paulo, Brazil) (M group, n = 20) or a femoral nerve block with insertion of a catheter for continuous infusion combined with a sciatic nerve block at the end of the surgery (FI group, n = 20)

Summary

Introduction

This study compares analgesia and postoperative bleeding achieved by intrathecal morphine with a continuous femoral plus single-shot sciatic nerve block. Several techniques using regional anesthesia may provide effective analgesia and early recovery, as well as prevent thromboembolic events. A rapid rehabilitation allows higher patient satisfaction and lower costs [1]. Regional anesthesia is superior to general anesthesia with better postoperative pain control without the use of opioids and its adverse effects. Analgesia can be extended longer into the postoperative period by means of continuous infusions through epidural catheters [2]. Spinal anesthesia plus opioids ensures quite effective analgesia, even though its side effects may delay the rehabilitation process [3, 4]

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