Tribloc (fémoral, sciatique, obturateur) pour la chirurgie ambulatoire arthroscopique de genou : étude prospective de faisabilité et d’efficacité

Abstract

Background The purpose of this study was to evaluate intra- and postoperative conditions of the triple nerve block technique (femoral, obturator, sciatic block) for outpatient knee arthrsopic procedures. Methods After written informed consent, ASA I-III patients received a combined triple nerve block with 30–40 ml lidocaine or mepivacaine (1,5%). Blocks were performed using a nerve stimulation technique. Onset time, block failure, supplemental general anesthesia (GA) or analgesia and pain score were recorded intraoperatively. After surgery, side effects (at days 0, 1, 3, 7 and after 4 weeks), patient and surgeon satisfactions were noted. Results Three hundred and twelve patients were screened and 115 triple blocks were performed (157 choosed GA, 19 spinal anaesthesia, 21 exclusion for regional anaesthesia). Failed blocks occurred for 12 (10%) patients. These 12 patients received GA before surgery incision. Time to complete block was 40 (10–60) min. Supplemental GA was required for 12 patients (12%) due to surgical ( n = 7, 7%) or tourniquet ( n = 5, 5%) pain. Intraoperative surgeon satisfaction was 90 (60–100). After surgery, time to discharge the postoperative care unit was 15 (5–60) min. Pain score at rest (Visual Analog Scale) until six hours was less than 30 /100, without any additionnal morphine. Two patients (< 2%) failed for ambulatory discharge criteria (no relation with triple block). At day 0, 3, 5% patients suffered PONV (8% at D1), paresthesia was noted in 1.7% at D0 (0,8% D3). No other secondary effects were observed after seven days and 91% patients “would like same anaesthesia” for next surgery. Conclusion We conclude that triple nerve block provided reliable intraoperative patient and surgical conditions for outpatient knee arthroscopy. Failed block (10%) was the major reason of supplemental anaesthesia. To increase surgical turn over under triple nerve block, a preoperative room may be required (block onset time).