Abstract
Background and Purpose: Postoperative pain after knee arthroplasty (TKA) is reported as severe in up to 60% of patients. Continuous femoral nerve blocks (CFNB) are a choice for major knee repair, but controversies remain about the need of supplemental sciatic nerve blocks (SNB) for better analgesia. Our aim is to assess the effect of the association of a SNB to a CFNB to reduce postoperative pain after TKA. Methods: A prospective randomized, single blinded, controlled study, on 50 patients undergoing TKA. Control group received a CFNB before general anesthesia; in the intervention group a single shot SNB was added after the CFNB was done. After the end of surgery all patients started a continuous local anesthetic infusion through the femoral catheter in the PACU (post-anesthesia care unit). Pain scores were measured in the PACU and at 12 h and 24 h postoperative using a visual analog scale (VAS). Results: VAS pain scores (mm) were lower and statistically significant for the intervention group up to 12 h postoperative: PACU admission mean VAS = 59.4 vs 30.2, P = 0.001; at 12 h mean VASr = 26.1 vs 9.2, P = 0.006; at 24 h mean VASr = 30.1 vs 32.7, P = 0.723. Conclusions: The association of a single shot SNB with a CFNB significantly reduces postoperative pain scores after TKA up to 12 h. At 24 h there are no differences between groups.
Highlights
Continuous femoral nerve blocks (CFNB) are a choice for major knee repair, but controversies remain about the need of supplemental sciatic nerve blocks (SNB) for better analgesia
Control group received a CFNB before general anesthesia; in the intervention group a single shot SNB was added after the CFNB was done
Regional anesthesia provides better postoperative analgesia, and may improve early rehabilitation with fewer side effects when compared to intravenous opiates [2,3], but there are no clear conclusions on what type of regional anesthesia is better
Summary
Postoperative pain is a concern for patients submitted to knee arthroplasty and it has been reported as being moderate in up to 30% and severe in 60% of the patients [1]. There is uncertainty on whether sciatic or obturator nerve blocks are needed as adjuncts to a femoral block to improve postoperative analgesia, and conflicting results have been published [6,7,8,9,10,11]. Two meta-analysis recently published showed inconclusive evidence to define the effect of adding sciatic nerve block (SNB) to femoral nerve block (FNB) on acute pain and related outcomes due to the lack of good randomized studies comparing both techniques [13]. Continuous femoral nerve blocks (CFNB) are a choice for major knee repair, but controversies remain about the need of supplemental sciatic nerve blocks (SNB) for better analgesia. Conclusions: The association of a single shot SNB with a CFNB significantly reduces postoperative pain scores after TKA up to 12 h.
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