Block In Total Knee Arthroplasty Research Articles

122: Comparison of spinal anaesthesia and combined lumbar plexus and sciatic nerve block for total knee arthroplasty (TKA)

122: Comparison of spinal anaesthesia and combined lumbar plexus and sciatic nerve block for total knee arthroplasty (TKA)

Effect of Preemptive Analgesia on Postoperative Pain after Total Knee Arthroplasty

Background: Postoperative pain management is critical for optimal care of orthopedic surgical patients. Preemptive analgesia such as neuraxial blocks and methods of drug delivery system such as infusion pumps may be used after total knee arthroplasty. The aim of this study was to examine the analgesic and pre-emptive effect of continuous epidural block initiated before total knee arthroplasty upon postoperative period. Methods: A double-blind randomized study was performed in thirty-nine patients scheduled for total knee arthroplasty. Group 1 (n = 20) received continuous epidural block with 2% lidocaine 15 ml initiated 20 min before general anesthesia (pre-emptive group) and Group 2 (n = 19) received continuous epidural block postoperatively, followed by a continuous epidural infusion with 0.125% bupivacaine and fentanyl until 72 hr after operation. In both groups general anesthesia was done. Preoperative vital signs and post-incisional vital signs were checked. VAS score were recorded at 1, 2, 3, 4, 5, 6, 7 days postoperatively and side effects and patients satisfaction were assessed. Results: VAS at rest was significantly less (P ＜ 0.05) in group 1 than group 2 between 2 days and 7 days after surgery except 1 day after surgery. There was no intergroup difference in the incidence of side effects. More patients in group 1 were satisfied than group 2. Conclusions: Preoperative continuous epidural block in total knee arthroplasty reduces postoperative pain and the timing of analgesic treatment is most important to obtain effective analgesia.

Patient satisfaction and effectiveness of lumbar plexus and sciatic nerve block for total knee arthroplasty

The purpose of this study was to evaluate the efficacy of combined lumbar plexus block techniques for total knee arthroplasty. Long-acting local anesthetics were used to ensure adequate intraoperative and postoperative anesthesia and analgesia. All patients undergoing total knee arthroplasty at our institution were offered lumbar plexus block after obtaining informed consent. Patients for study were a continuous group of 87 patients over a 1-year period. A subset of 40 patients was studied for postoperative analgesia effect. All patients were contacted by phone for a satisfaction survey. There were 87 patients who received initial lumbar plexus and sciatic nerve blocks, 78% (68 of 87) of whom had adequate initial blocks. Sixteen patients (22%) required conversion to general anesthesia intraoperatively because of inadequate anesthesia. A subset of patients studied for postoperative analgesia revealed an average time of 13 hours before the first request for supplemental narcotics. There were no complications related to the lumbar plexus block in our study group of patients. There was a 92% overall satisfaction rate with the anesthesia provided by the lumbar plexus block. Lumbar plexus block can be used successfully for total knee arthroplasty. Lumbar plexus block appears to have advantages for early postoperative analgesia, leading to increased patient comfort and satisfaction.

Urinary tract infection in patients with rheumatoid arthritis.

Urinary tract infection in patients with rheumatoid arthritis.