股神经联合坐骨神经阻滞应用在踝关节镜手术中的效果评价

目的 比较两种不同的麻醉方式在踝关节镜手术中的应用效果。方法 选择2018年1月至2019年12月在中山大学孙逸仙纪念医院行踝关节镜手术的患者60例,随机分为股神经组和腰丛组,每组各30例,股神经组实施股神经联合坐骨神经阻滞,腰丛组实施腰丛联合坐骨神经阻滞。比较两组患者术中和术后的麻醉和镇痛效果、麻醉操作时间、不同时间的心率及平均血压和麻醉并发症及不良反应。结果 两组患者术中额外使用局麻药和麻醉性镇痛药人数、术后24小时内静息或运动的VAS评分及额外使用镇痛药的人数和使用时间差异均无统计学意义;股神经组麻醉操作时间显著少于腰丛组;股神经组在麻醉操作过程中的心率和平均血压显著低于腰丛组;两组患者术后不良反应比较差异无统计学意义。结论 股神经联合坐骨神经阻滞与腰丛联合坐骨神经阻滞在踝关节镜手术中的麻醉和术后镇痛效果无显著差别,但前者麻醉操作时间更短,围术期生命体征更平稳。     

Network meta-analysis of the analgesic effectiveness of regional anaesthesia techniques for anterior cruciate ligament reconstruction

Anterior cruciate ligament reconstruction can cause moderate to severe acute postoperative pain. Despite advances in our understanding of knee innervation, consensus regarding the most effective regional anaesthesia techniques for this surgical population is lacking. This network meta-analysis compared effectiveness of regional anaesthesia techniques used to provide analgesia for anterior cruciate ligament reconstruction. Randomised trials examining regional anaesthesia techniques for analgesia following anterior cruciate ligament reconstruction were sought. The primary outcome was opioid consumption during the first 24 h postoperatively. Secondary outcomes were: rest pain at 0, 6, 12 and 24 h; area under the curve of pain over 24 h; and opioid-related adverse effects and functional recovery. Network meta-analysis was conducted using a frequentist approach. A total of 57 trials (4069 patients) investigating femoral nerve block, sciatic nerve block, adductor canal block, local anaesthetic infiltration, graft-donor site infiltration and systemic analgesia alone (control) were included. For opioid consumption, all regional anaesthesia techniques were superior to systemic analgesia alone, but differences between regional techniques were not significant. Single-injection femoral nerve block combined with sciatic nerve block had the highest p value probability for reducing postoperative opioid consumption and area under the curve for pain severity over 24 h (78% and 90%, respectively). Continuous femoral nerve block had the highest probability (87%) of reducing opioid-related adverse effects, while local infiltration analgesia had the highest probability (88%) of optimising functional recovery. In contrast, systemic analgesia, local infiltration analgesia and adductor canal block were each poor performers across all analgesic outcomes. Regional anaesthesia techniques that target both the femoral and sciatic nerve distributions, namely a combination of single-injection nerve blocks, provide the most consistent analgesic benefits for anterior cruciate ligament reconstruction compared with all other techniques but will most likely impair postoperative function. Importantly, adductor canal block, local infiltration analgesia and systemic analgesia alone each perform poorly for acute pain management following anterior cruciate ligament reconstruction.     

Comparison of Local Infiltration of Analgesia and Sciatic Nerve Block in Addition to Femoral Nerve Block for Total Knee Arthroplasty

We conducted a prospective randomized controlled trial to test the null hypothesis that there is no difference between sciatic nerve block (SNB) and local infiltration of analgesia (LIA) regarding postoperative analgesia after total knee arthroplasty (TKA), when administrated in addition to femoral nerve block (FNB). Forty-six patients scheduled for TKA were randomized into two groups: concomitant administration of FNB and SNB or FNB and LIA. Average pain scores during the first 21 days after surgery were similar in the two groups and remained at low level. There was no significant difference in the need for adjuvant analgesics, patient satisfaction level, the time to achieve rehabilitation goals, and length of hospital stay. The LIA offers a potentially safer alternative to SNB as an adjunct to FNB.     

The adductor canal catheter and interspace between the popliteal artery and the posterior capsule of the knee for total knee arthroplasty

Analgesia for total knee arthroplasty (TKA) is not a new topic; however, some newer approaches to peripheral nerve blocks for control of postoperative pain have been developed. The femoral nerve block plus or minus a sciatic nerve block has been shown to provide effective analgesia, but not without some degree of motor block. The adductor canal block provides analgesia not inferior to a femoral with less motor weakness, and a continuous catheter technique can be used to prolong its effects. Blocking the sciatic nerve has been a subject of controversy, in part because of the motor weakness but also because of the inclusion of the common peroneal nerve, a nerve that can potentially be damaged by TKA. An infiltration of the interspace between the popliteal artery and the capsule of the posterior knee, provides analgesia for the posterior knee without motor effects or common peroneal block. The combination of an adductor canal catheter and an interspace between the popliteal artery and the capsule of the posterior knee provides a balance of effective postoperative analgesia and preservation of motor function, ultimately shortening length of stay following TKA.     

Single-Injection Femoral and Sciatic Nerve Blocks for Pain Control After Total Knee Arthroplasty

This study was designed to evaluate the addition of a single-injection sciatic nerve block to a femoral nerve block for analgesia after total knee arthroplasty. Fifty-seven patients undergoing primary total knee arthroplasty were randomized to receive femoral nerve blockade or a sham block. A subsequent 31 patients received both femoral and sciatic nerve blocks (FSNBs) before general anesthesia. Intravenous morphine use and visual analog pain scale scores were recorded at regular intervals. Femoral and sciatic nerve blocks were placed in less than five minutes, on average. Lower visual analog pain scale scores were noted in both femoral nerve blockade and FSNB groups compared to shams through 48 hours. Morphine use was significantly lower in the FSNB group. Femoral and sciatic nerve block can be placed quickly and consistently in the operating room with improved postoperative pain relief and reduced narcotic consumption.     

Anesthesia and postoperative analgesia after percutaneous hallux valgus repair in ambulatory patients

Background

Postoperative pain is often severe after hallux valgus repair. Sciatic nerve blocks with long-acting local anesthetics have been recommended for surgical anesthesia and postoperative analgesia. However, a novel percutaneous approach may require less analgesia and make the procedure suitable for ambulatory care. We thus tested the hypothesis that mid-foot block and sciatic nerve blocks provide comparable surgical anesthesia and postoperative analgesia, but that patients ambulate independently sooner after mid-foot block.

Study design

Prospective, randomized study.

Methods

Forty patients scheduled for ambulatory percutaneous hallux valgus repair were randomly assigned to two anesthesia and analgesia blocks: foot infiltration achieved by a mild foot block, or sciatic nerve block (30 mL of 7.5% ropivacaine for each block). Surgery was performed without sedation or additional analgesia. Both groups were given oral paracetamol/codeine and ketoprofene systematically; tramadol was added if necessary. Walking ability and pain scores were assessed for 48 postoperative hours.

Results

Demographic and morphometric characteristics, and duration of surgery were similar in each group. Pain scores were comparable and low in each group at rest and while walking. The time to ambulation without assistance was significantly less for patients in the infiltration group (3.8 ± 1.4 hours) than patients in the sciatic group (19.2 ± 9.5 hours; P < 0.0001).

Conclusion

After percutaneous hallux valgus repair, mid-foot block and sciatic nerve block provided comparable postoperative analgesia. However, mid-foot block seems preferable since the time to ambulation without assistance is much reduced.     

Using stimulating catheters for continuous sciatic nerve block shortens onset time of surgical block and minimizes postoperative consumption of pain medication after halux valgus repair as compared with conventional nonstimulating catheters

We prospectively tested the hypothesis that the use of a stimulating catheter improves the efficacy of continuous posterior popliteal sciatic nerve block in 100 randomized patients scheduled for elective orthopedic foot surgery. After eliciting a sciatic mediated muscular twitch at < or = 0.5 mA nerve stimulation output, the perineural catheter was advanced 2-4 cm beyond the tip of the introducer either blindly (Group C; n = 50) or stimulating via the catheter (Group S; n = 50). A bolus dose of 25 mL of 1.5% mepivacaine was followed by a postoperative patient-controlled infusion of 0.2% ropivacaine (basal infusion: 3 mL/h; incremental dose: 5 mL; lockout time: 30 min). Propacetamol 2 g IV was administered every 8 h, and opioid rescue analgesia was available if required. Catheter placement required 7 +/- 2 min in Group S and 5 +/- 2 min in Group C (P = 0.056). A significantly shorter onset time of both sensory and motor blocks was noted in Group S. No difference in quality of pain relief at rest and during motion was reported between the groups. Median (range) local anesthetic consumption during the first 48 h after surgery was 239 mL (175-519 mL) and 322 mL (184-508 mL) in Groups S and C, respectively (P = 0.002). Rescue opioid analgesia was required by 12 (25%) and 28 (58%) patients in Groups S and C, respectively (P = 0.002). We conclude that the use of a stimulating catheter results in shorter onset time of posterior popliteal sciatic nerve block, similar pain relief with reduced postoperative consumption of local anesthetic solution, and less rescue opioid consumption. IMPLICATIONS: This prospective, randomized, blind investigation demonstrated that the use of a stimulating catheter for continuous posterior popliteal sciatic nerve block resulted in shorter onset time of sensory and motor blocks and less local anesthetic consumption and need for rescue pain medication after elective orthopedic foot surgery compared with blind catheter advancement.     

Alkalinisation of bupivacaine for sciatic nerve blockade

This double-blind study investigates the effect of pH adjustment of bupivacaine 0.5% with adrenaline 1:200,000 on block latency, duration of analgesia and systemic absorption of local anaesthetic after sciatic nerve blockade. Twenty-four adult patients were randomly allocated into one of two groups: Group A (n = 12) received bupivacaine with adrenaline 1:200,000 (pH 3.9) 2 mg/kg, while Group B (n = 12) received alkalinised bupivacaine with adrenaline 1:200,000 (pH 6.4) 2 mg/kg. Increasing the pH of the local anaesthetic solution significantly reduced block latency from 25 minutes in Group A to 12.5 minutes in Group B (p less than 0.001) and prolonged the duration of useful analgesia from 14.1 hours to 18.3 hours (p less than 0.001). There was no significant difference in plasma bupivacaine levels between the two groups. The results indicate that alkalinisation of bupivacaine reduces time to onset and prolongs the duration of useful analgesia when used for sciatic nerve blockade, without significantly increasing systemic absorption.     

The effect of stimulating versus conventional perineural catheters on postoperative analgesia following ultrasound-guided femoral nerve localization

Study Objective

To test the hypothesis that, if the femoral nerve is correctly localized using ultrasound (US) guidance, the type of perineural catheter used has no effect on catheter success.

Design

Randomized controlled trial.

Setting

Post-anesthesia care unit of an academic teaching hospital.

Patients

40 ASA physical status 1, 2, and 3 patients, ages 55-85 years, undergoing elective total knee arthroplasty.

Interventions

All patients received postoperative continuous femoral nerve blocks and a single injection sciatic nerve block. Nerve localization was accomplished using US guidance and electrical nerve stimulation so that the needle tip was visualized deep to the femoral nerve. Patients were randomized to receive either stimulating (Group SC) or nonstimulating catheters (Group NSC) in the usual manner for each device. Catheters were bolused with ropivacaine and an infusion commenced.

Measurements

The primary outcome was quality of analgesia (as measured by a numerical rating scale). Other outcomes included sensory block success rate, number of attempts and time required to localize the needle tip correctly, number of attempts and time required to place the perineural catheter, amount of local anesthetic and opioid use postoperatively, and degree of completion of preset postoperative rehabilitation goals.

Main Results

Quality of analgesia was similar at all time intervals. Rates of successful femoral block (95% vs 80%; P = 0.34) were similar between groups. Time required to position the catheter was greater in Group SC than Group NSC (3.45 ± 2.05 min vs 1.72 ± 0.88 min; P < 0.01).

Conclusions

Ultrasound guidance for needle localization prior to catheter insertion for femoral nerve block results in similar block characteristics between stimulating and nonstimulating catheters. The use of nonstimulating catheters avoids the technical challenges of stimulating catheters and does not require additional helpers.     

The analgesic efficacy of sciatic nerve block in addition to femoral nerve block in patients undergoing total knee arthroplasty: a systematic review and meta‐analysis

The aim of this meta‐analysis was to assess the postoperative analgesic efficacy of sciatic nerve block when combined with femoral nerve block after total knee arthroplasty. Outcomes included resting pain scores (analogue scale, 0–100), intravenous morphine consumption at 12 h, 24 h and 48 h postoperatively, and functional outcomes comprising knee flexion, distance walked, and length of stay. Twelve randomised controlled trials were included, with a total of 600 patients. When combined with femoral nerve block, sciatic nerve block significantly reduced resting pain scores at 12 h postoperatively with a mean difference of 10 (95% CI: ?15 to ?5; p < 0.00001). Resting pain scores at 24 h, and intravenous morphine consumption at 12 h, 24 h and 48 h postoperatively were also significantly reduced, but without clinical significance beyond 12 h and without affecting functional outcomes. In conclusion, sciatic nerve block confers additional postoperative analgesia within the first 12 postoperative hours compared with femoral nerve block alone for patients undergoing total knee arthroplasty.     

坐骨神经阻滞和关节周围局部浸润麻醉对全膝关节置换术后镇痛效果的比较

目的比较坐骨神经阻滞和关节周围局部浸润麻醉对全膝关节置换手术术后镇痛效果的差异。方法采用前瞻性研究方法,33名符合条件的全膝关节手术患者,ASA分级Ⅰ或Ⅱ级,分为坐骨神经阻滞组(SNB组,16例,术毕给予0.375%罗哌卡因20 mL进行坐骨神经阻滞);局部浸润麻醉组(LIA组,17例,术毕给予0.2%的罗哌卡因150 mL加曲马多100 mg和0.5mg肾上腺素混合液行膝关节周围局部浸润麻醉)。于术后2 h、8 h、16 h、24 h、36 h、48 h评估静止状态下和活动状态下VAS评分分值的变化;观察术后恶心呕吐发生,局麻药中毒症状,皮疹发生,KSS评分在两组患者中的状况。结果 (1)与SNB组相比,术后2 h、8 h、16 h LIA组患者静止状态下的VAS评分偏高,差异有统计学意义(P0.01),但术后24 h、36 h和48 h LIA组患者的评分降低,差异有统计学意义(P0.01);(2)与SNB组相比,LIA组患者术后2 h、8 h运动状态下VAS评分偏高,差异有统计学意义(P0.01),LIA组患者在术后16 h、24 h、36 h和48 h的评分降低,差异有统计学意义(P0.01);(3)两组患者术后恶心呕吐发生,局麻药中毒症状,皮疹发生,KSS评分情况,差异无统计学意义。结论 SNB或者LIA都能为全膝关节手术提供良好的术后镇痛效果,但从操作便捷的角度来看,后者更适用于此类手术。     

Post-operative analgesia following total knee replacement: an evaluation of the addition of an obturator nerve block to combined femoral and sciatic nerve block

BACKGROUND: Femoral and sciatic nerve block may not provide complete post-operative analgesia following total knee replacement. This study was designed to evaluate whether the addition of an obturator nerve block to combined femoral and sciatic nerve block improves the quality of post-operative analgesia following primary total knee replacement. METHODS: Sixty patients were randomised into one of two groups: combined femoral and sciatic nerve block with 15 ml 0.75% ropivacaine to each nerve or combined femoral and sciatic nerve block with 15 ml 0.75% ropivacaine to each nerve and an obturator nerve block with 5 ml 0.75% ropivacaine. RESULTS: Peripheral nerve blocks were successful in 85% of patients. The group which received the obturator nerve block showed a significant increase in the time until their first request for analgesia (mean 257.0 vs. 433.6 min) and a significant reduction in the total requirements for morphine throughout the study period (mean 83.8 vs. 63.0 mg) (P<0.05). There were no systemic or neurological sequelae in any of the groups. CONCLUSIONS: The addition of an obturator nerve block to femoral and sciatic blockade improved post-operative analgesia following total knee replacement.     

改良髂筋膜间隙联合腘窝坐骨神经阻滞在单侧大隐静脉曲张手术中的应用

目的观察改良髂筋膜间隙联合腘窝坐骨神经阻滞在单侧大隐静脉曲张手术中的麻醉效果。方法选择择期行单侧大隐静脉高位结扎加抽剥术患者60例,男32例,女28例,年龄42~76岁,ASAⅠ或Ⅱ级,采用随机数字表法将其分为改良髂筋膜间隙联合腘窝坐骨神经阻滞组(N组)和硬膜外阻滞组(E组),每组30例。N组先行腘窝坐骨神经阻滞,再在超声图像上确认髂筋膜和股神经位置,先行股神经阻滞,再在同一穿刺点从缝匠肌内侧缘开始,由外向内沿髂筋膜下给1%利多卡因10ml和0.5%罗哌卡因10ml,同时超声探头在腹股沟韧带水平向内移动,内侧达股动脉上方;E组采用L2~3间隙行硬膜外阻滞。记录两组阻滞前(T0)、阻滞后10min(T1)、30min(T2)、60min(T3)的SBP、DBP及HR;记录两组阻滞完成时间、感觉阻滞起效时间、术中麻黄碱使用情况、麻醉效果及术后48h恶心呕吐、头痛及尿潴留发生情况。结果与T0时比较,T2时E组的SBP和DBP明显降低(P0.05),T2时N组SBP和DBP明显高于E组(P0.05);N组感觉阻滞起效时间明显短于E组、术中麻黄碱使用率明显低于E组(P0.05);E组整体麻醉效果优于N组(P0.05),但两组麻醉效果优良率差异无统计学意义;术后48hN组尿潴留发生率明显低于E组(P0.05)。结论改良髂筋膜间隙联合腘窝坐骨神经阻滞用于单侧大隐静脉高位结扎加抽剥术中,麻醉效果良好,较硬膜外阻滞具有血流动力学影响小、术后并发症少及适应证更广等优点。     

Regional anesthesia in knee arthroscopy: A new technique involving femoral and sciatic nerve blocks in knee arthroscopy

We describe a new anesthetic technique of femoral and sciatic nerve blocks in knee arthroscopy. The sciatic nerve block is administered through a posterior approach, and the block of the femoral and lateral femoral cutaneous nerves in a single anterior approach. This type of regional anesthesia is safe and effective, providing excellent intraoperative and postoperative analgesia as well as minimizing postoperative complications.     

两种麻醉方法用于老年糖尿病患者胫骨横向骨搬移术的比较

目的比较两种麻醉方法在老年糖尿病患者胫骨横向骨搬移术中的效果。方法选择拟行单侧胫骨横向骨搬移术患者60例,男30例,女30例,年龄65～89岁,ASA II级,BMI 18～24 kg/m~2。随机分为腘窝处坐骨神经联合股神经阻滞组(NB组)和硬膜外麻醉组(EA组)。NB组在超声引导下正确定位坐骨神经和股神经后分别给予0.375%罗哌卡因各15～20 ml。EA组取L_(2～3)穿刺点行硬膜外麻醉,2%利多卡因3 ml试验剂量后,分次给予0.75%罗哌卡因10～15 ml。记录两组患者术中输液量、使用麻黄碱情况。记录两组患者阻滞前、阻滞后10、20、30、60 min和术后60 min的HR和MAP。记录两组患者感觉和运动神经阻滞起效时间、完善时间、持续时间。记录有无穿刺部位出血、局麻药不良反应、新发神经系统病变,记录尿潴留、恶心呕吐等不良反应发生情况。结果 NB组术中输液量、术中使用麻黄碱例数明显少于EA组(P0.05)。与阻滞前比较,阻滞后10、20、30、60 min和术后60 min EA组MAP明显降低(P0.05),阻滞后10、20、30、60 min和术后60 min NB组MAP明显高于EA组(P0.05),两组HR差异无统计学意义。两组患者感觉、运动神经阻滞起效时间和完善时间差异无统计学意义。NB组感觉神经阻滞持续时间明显长于EA组(P0.05),运动神经阻滞持续时间明显短于EA组(P0.05)。两组患者均无一例出现穿刺部位出血、局麻药中毒及新发神经系统病变。NB组尿潴留和恶心呕吐发生率明显低于EA组(P0.01)。结论与硬膜外麻醉相比较,坐骨神经联合股神经阻滞应用于老年糖尿病患者胫骨横向骨搬移术,对血流动力学影响小,阻滞效果好、术后镇痛时间长,不增加并发症发生。     

Sciatic nerve block by the lateral route at the level of the popliteal fossa with 0.75% ropivacine: advantages of a more proximal approach

OBJECTIVES: To assess the efficacy of a sciatic nerve block using a lateral approach 11 cm cephalad to the lateral femoral epicondyle for providing surgical anesthesia and postoperative analgesia in scheduled foot surgery (hallux valgus) after a single injection of 30 mL of 0.75% ropivacaine. METHODS: A block was performed in 30 patients using a point of puncture 11 cm cephalad to the most prominent point of the lateral femoral epicondyle in the groove between the biceps femoris and vastus lateralis muscles. Once the nerve had been located with a stimulator (2 Hz, 0.5 mA), 30 mL of 0.75% ropivacaine was injected. Data recorded were time until block, number of attempts, depth at which the nerve was found, sciatic nerve response obtained, and time until the sensory block was complete. We evaluated quality of anesthesia during surgery, duration of postoperative analgesia, and patient discomfort during performance of the block. RESULTS: Time required to perform the block was 4.3 +/- 1.2 minutes and only one puncture attempt was needed in 27 patients. The nerve was located at 5.5 +/- 0.4 cm, with response located in the common peroneal nerve in 18 patients and in the posterior tibial nerve in 12. The time needed to achieve a full sensory block was 19.3 +/- 5.1 minutes. Twenty-six patients (86%) were very satisfied with the anesthetic quality of the block, 2 were moderately satisfied, and 2 were dissatisfied. Postoperative analgesia lasted 19 +/- 3.4 hours. Four patients reported minimal discomfort during performance of the block. No complications were observed. CONCLUSIONS: The sciatic nerve block from a lateral approach 11 cm cephalad to the lateral femoral epidondyle is an appropriate anesthetic technique for foot surgery. It is safe, effective and easy to perform. Infusion of 30 mL of 0.75% ropivacaine provided adequate anesthesia and long-lasting postoperative analgesia for our patients.     

Does the sciatic nerve approach influence thigh tourniquet tolerance during below-knee surgery?

In this prospective, randomized, blinded study we assessed thigh tourniquet tolerance when a Labat's or a posterior popliteal approach of the sciatic nerve was used for below-knee surgery. One-hundred-twenty patients were divided into two groups of 60. A posterior popliteal (Group 1) or a Labat's (Group 2) sciatic nerve block was performed with 25 mL 1% mepivacaine + epinephrine 1:200,000. In both groups, a femoral nerve block was achieved. Patient comfort during block performance, sensory block, success rate, and thigh tourniquet tolerance were recorded. Performance of the block was significantly more comfortable in Group 1 than in Group 2 (P < 0.01). Completeness of the block at t(30 min.) and success rate were comparable in both groups. Thigh tourniquet pain increased with time in both groups. No statistically significant difference was observed between groups. We conclude that despite a complete sensory blockade of the posterior femoral cutaneous nerve in 91% of the patients, Labat's approach of the sciatic nerve provides no better thigh tourniquet tolerance than the popliteal approach. The popliteal approach is as efficient but more comfortable for the patient and is the preferred technique for below-knee surgery.     

Sciatic nerve block with 1% mepivacaine for foot surgery: posterior versus lateral approach to the popliteal fossa

AIMS: To compare the efficacy and feasibility of the sciatic nerve block performed using either a posterior or a lateral approach to the popliteal fossa, taking into consideration patient comfort during puncture and postoperative analgesia. PATIENTS AND METHODS: Sixty patients scheduled for foot surgery were randomly assigned to 2 groups: a posterior approach was used in performing the sciatic nerve block in 1 group (n = 30) and a lateral approach was in the other group (n = 30). The local anesthetic employed was mepivacaine 1%. RESULTS: Duration of sensory block was used significantly longer with the lateral approach (5.4 hours, range 3.3-8 hours) than with the posterior approach (4.4 hours, range 1.5-7 hours) (P < 0.001). Time to onset of the block was significantly shorter with the lateral approach (10 minutes, range 5-25 minutes) than with the posterior approach (17 minutes, range 4-45 minutes) (P < 0.01). Quality of the blockade was similar with both approaches. CONCLUSIONS: The lateral approach to the block of the sciatic nerve in the popliteal fossa provides analgesia comparable to that obtained with the posterior approach, with a faster onset and longer postoperative duration.     

Combined Femoral and Sciatic Nerve Block vs Combined Femoral and Periarticular Infiltration in Total Knee Arthroplasty : A Randomized Controlled Trial

This study tests the null hypothesis that there is no difference between sciatic nerve block (SNB) and periarticular anesthetic infiltration (PI) as adjuncts to femoral nerve blockade (FNB) in total knee arthroplasty in terms of postoperative opioid requirements. Fifty-two patients undergoing total knee arthroplasty were randomized to receive either (a) combined FNB-SNB or (b) combined FNB-PI. Average morphine consumption in the first 24 (20 vs 23 mg) and 48 hours (26 vs 33 mg) showed no significant difference. Visual Analogue Scale scores, knee flexion (60° vs 67.5°) and extension lag (0° vs 5°) were comparable. Anesthetic time, surgical time, and length of hospital stay (5.5 vs 6 days) were similar. This study showed no significant difference between the 2 groups. The PI offers a practical and potentially safer alternative to SNB.     

Extended femoral nerve sheath block after total hip arthroplasty: continuous versus patient-controlled techniques

We assessed the efficacy of patient-controlled analgesia (PCA) techniques for extended femoral nerve sheath block after total hip arthroplasty. Forty-five patients were divided into three groups of 15. Over 48 h, all patients received 0.125% bupivacaine with clonidine 1 microg/mL and sufentanil 0.1 microg/mL via a femoral nerve sheath catheter as a continuous infusion at 10 mL/h in Group 1, as PCA boluses only of 10 mL/h in Group 2, or as PCA boluses of 5 mL per 30 min in Group 3. Pain scores, sensory block, supplemental analgesia, bupivacaine consumption, side effects, and satisfaction scores were recorded. Pain scores at rest and supplemental analgesia were comparable in the three groups. At 48 h, pain relief on movement was significantly better in Group 3 than in Group 1 (P = 0.01). Bupivacaine consumption was significantly less in Groups 2 and 3 than in Group 1 (P < 0.001). Side effects were comparable in the three groups. Satisfaction scores were significantly higher in Group 3 than in the other groups (P < 0.01). We conclude that, to maintain extended femoral nerve sheath block after total hip arthroplasty, PCA techniques reduce the local anesthetic consumption without compromise in patient satisfaction or visual analog scale scores. Of the two PCA techniques tested, PCA boluses (5 mL per 30 min) of 0.125% bupivacaine with clonidine 1 microg/mL and sufentanil 0.1 microg/mL are associated with the smallest local anesthetic consumption and the most patient satisfaction.