A comparison of femoral/sciatic nerve block with lateral femoral cutaneous nerve block and combined spinal epidural anesthesia for total knee replacement arthroplasty

다국어 초록 (Multilingual Abstract)

Background: Several factors, such as compromised cardiopulmonary function, anticoagulative therapy, or anatomical deformity in the elderly, prevent general anesthesia and neuraxial blockade from being conducted for total knee replacement arthroplasty (TKRA). We investigated the efficacy of femoral/sciatic nerve block with lateral femoral cutaneous nerve block (FSNB) as an alternative procedure in comparison with combined spinal epidural nerve block (CSE) in patients undergoing TKRA.
Methods: In this observational study, 80 American Society of Anesthesiologists physical status I-III patients scheduled for elective unilateral TKRA underwent CSE (n = 40) or FSNB (n = 40). Perioperative side effects, intraoperative medications, duration and remaining amount of intravenous patient-controlled analgesia, rate of satisfaction with the surgical anesthesia and postoperative analgesia, willingness to recommend the same surgical anesthesia and postoperative analgesia to others, and postoperative visual analog scale pain scores were assessed. Statistical analysis was done using Chi-square test, Student’s t-test, and repeated-measures analysis of variances.
Results: There was significantly more use of antihypertensives, analgesics, and sedatives in the FSNB group. There were no significant differences of perioperative side effects, duration and remaining amount of intravenous patient-controlled analgesia, rate of satisfaction with the surgical anesthesia and postoperative analgesia, willingness to recommend the same surgical anesthesia and postoperative analgesia to others, and postoperative visual analog scale scores between the two groups.
Conclusions: FSNB with a sophisticated use of antihypertensives, analgesics, and sedatives to supplement insufficient block offers a practical alternative to CSE for TKRAs.

참고문헌 (Reference)

1 Orebaugh SL, "Ultrasound guidance with nerve stimulation reduces the time necessary for resident peripheral nerve blockade" 32 : 448-454, 2007

2 Ganidagli S, "The comparison of two lower extremity block techniques combined with sciatic block: 3-in-1 femoral block vs. psoas compartment block" 59 : 771-776, 2005

3 Moen V, "Severe neurological complications after central neuraxial blockades in sweden 1990-1999" 101 : 950-959, 2004

4 Howell SJ, "Risk factors for cardiovascular death after elective surgery under general anaesthesia" 80 : 14-19, 1998

5 Macalou D, "Postoperative analgesia after total knee replacement: the effect of an obturator nerve block added to the femoral 3-in-1 nerve block" 99 : 251-254, 2004

6 McNamee DA, "Post-operative analgesia following total knee replacement: an evaluation of the addition of an obturator nerve block to combined femoral and sciatic nerve block" 46 : 95-99, 2002

7 Allen HW, "Peripheral nerve blocks improve analgesia after total knee replacement surgery" 87 : 93-97, 1998

8 Fanelli G, "Nerve stimulator and multiple injection technique for upper and lower limb blockade: failure rate, patient acceptance, and neurologic complications. Study Group on Regional Anesthesia" 88 : 847-852, 1999

9 Green L, "Managing anticoagulated patients during neuraxial anaesthesia" 149 : 195-208, 2010

10 Marhofer P, "Magnetic resonance imaging of the distribution of local anesthetic during the three-inone block" 90 : 119-124, 2000

11 Hirst GC, "Femoral nerve block. Single injection versus continuous infusion for total knee arthroplasty" 21 : 292-297, 1996

12 Rawal N, "Epidural versus combined spinal epidural block for cesarean section" 32 : 61-66, 1988

13 Davies AF, "Epidural infusion or combined femoral and sciatic nerve blocks as perioperative analgesia for knee arthroplasty" 93 : 368-374, 2004

14 Capdevila X, "Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery" 91 : 8-15, 1999

15 Singelyn FJ, "Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous three-in-one block on postoperative pain and knee rehabilitation after unilateral total knee arthroplasty" 87 : 88-92, 1998

16 Etches RC, "Continuous intravenous administration of ketorolac reduces pain and morphine consumption after total hip or knee arthroplasty" 81 : 1175-1180, 1995

17 Chelly JE, "Continuous femoral blocks improve recovery and outcome of patients undergoing total knee arthroplasty" 16 : 436-445, 2001

18 Serpell MG, "Comparison of lumbar plexus block versus conventional opioid analgesia after total knee replacement" 46 : 275-277, 1991

19 Rawal N, "Combined spinal-epidural technique" 22 : 406-423, 1997

20 Eifert B, "Combined "3-in- 1"/sciatic nerve block. Block effectiveness, serum level and side effects using 700 mg mepivacaine 1% without and with adrenaline and prilocaine 1%" 45 : 52-58, 1996

21 Yang WT, "Anatomy of the normal brachial plexus revealed by sonography and the role of sonographic guidance in anesthesia of the brachial plexus" 171 : 1631-1636, 1998

22 Hogan MV, "Analgesia for total hip and knee arthroplasty: A review of lumbar plexus, femoral, and sciatic nerve blocks" 38 : E129-E133, 2009

23 Bouaziz H, "An evaluation of the cutaneous distribution after obturator nerve block" 94 : 445-449, 2002

24 Zaric D, "A comparison of epidural analgesia with combined continuous femoral-sciatic nerve blocks after total knee replacement" 102 : 1240-1246, 2006