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

Jong Hae Kim, Myoung Rae Cho, Si Oh Kim, Jung Eun Kim, Dong Keun Lee, Woon Seok Roh, Jong Hae Kim, Myoung Rae Cho, Si Oh Kim, Jung Eun Kim, Dong Keun Lee, Woon Seok Roh

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.

Keywords: Epidural anesthesia; Femoral nerve; Nerve block; Sciatic nerve; Spinal anesthesia; Total knee replacement.

Figures

Fig. 1
Fig. 1
Rate of satisfaction with surgical anesthesia and postoperative analgesia. Data are expressed as the mean ± SEM. CSE: combined spinal epidural anesthesia, FSNB: femoral/sciatic nerve block with lateral femoral cutaneous nerve block.
Fig. 2
Fig. 2
Numbers of patients who are willing to recommend the same surgical anesthesia and postoperative analgesia. CSE: combined spinal epidural anesthesia, FSNB: femoral/sciatic nerve block with lateral femoral cutaneous nerve block.
Fig. 3
Fig. 3
Visual analog scale score plotted against postoperative hours in the CSE and FSNB groups. Data are expressed as the mean ± SEM. There are no significant changes in VAS scores during postoperative period in each group, and no significant difference of VAS scores between the two groups. CSE: combined spinal epidural anesthesia, FSNB: femoral/sciatic nerve block with lateral femoral cutaneous nerve block.

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