The Effect of Unilateral Spinal Anaesthesia and Psoas Compartment with Sciatic Block on the Postoperative Pain Management in Total Knee Artroplastic Surgery.

Ebru Canakci,Yunus Guzel,Dogus Unal

doi:10.1155/2017/4127424

Abstract

Purpose. This study was designed to investigate the effects of peripheral nerve block methods, applied through unilateral spinal anaesthesia on elderly patients to undergo total knee arthroplasty, on perioperative hemodynamic parameters and postoperative analgesia period. Materials and Method. 60 patients were randomly divided into two groups in the study. In group USA spinal anaesthesia was performed. In group PCS it was applied on psoas compartment block and sciatic nerve block. Results. Significantly higher intraoperative 60th and 90th minute mean arterial pressure values were ascertained in the PCS group compared to the USA group. The decrease observed in the 5th, 10th, and 20th minute MAP values in the USA group was statistically significant according to the control MAP value. Concerning within group comparisons, the decrease in 5th, 10th, and 20th minute heart rate values in the USA group was statistically significant compared with the control measurement value. The mean beginning time of sensory and motor blocks in the PCS group was found to be at a significantly advanced level compared with that in the USA group. Conclusions. The PCS block technique using bupivacaine hydrochloride ensured a higher haemodynamic efficiency in the perioperative period in high-risk elderly patients undergoing total knee arthroplasty. This trial is registered with ClinicalTrials.gov Identifier: NCT03021421.

Highlights

Majority of patients who undergo orthopaedic lower extremity surgery (OLES) such as total knee arthroplasty are in the advanced age group
The mean sensory and motor block beginning times, surgery beginning time, sensory block period time, motor block period time, and time of first analgesic need were significantly longer in the psoas compartment-sciatic (PCS) group compared to those in the USA group (p = 0.001)
Morbidity is significantly reduced during the perioperative period in terms of deep vein thrombosis, pulmonary embolism, transfusion need, pneumonia, respiration depression, myocardial infarction, and renal insufficiency in patients to whom peripheral nerve block is applied instead of general anaesthesia (GA) [4, 5]

Summary

Introduction

Majority of patients who undergo orthopaedic lower extremity surgery (OLES) such as total knee arthroplasty are in the advanced age group. Postoperative pain treatment of these patients poses a problem for anaesthetists [2]. Anaesthesia approach for these patients generally includes general anaesthesia (GA), central neuraxial block, and usage of systematic analgesic for postoperative pain treatment. Psoas compartment block (PCB) is an alternative approach used to overcome many side effects related to GA and central neuraxial block techniques. Sciatic nerve block combined with psoas compartment block ensures unilateral lower extremity anaesthesia. Sciatic nerve block combined with psoas compartment block is used as an alternative technique to central neuraxial block and GA. Lateral femoral cutaneous, and obturator nerves are simultaneously blocked with psoas compartment block [3]

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Conclusion