Femoral-Sciatic Nerve Blocks for Complex Outpatient Knee Surgery Are Associated with Less Postoperative Pain Before Same-day Discharge

Abstract

For complex knee surgery, the use of FSB was associated with less pain; the use of FNB or FSB (vs. no block) was associated with fewer hospital admissions.

Bloqueio 3-em-1 prolongado versus analgesia sistêmica no tratamento da dor pós-operatória após a reconstrução do ligamento cruzado anterior do joelho

“…Edkin et al 20 showed the utility of a single-shot dose in femoral block to reduce the postoperative pain in patients with ACL reconstruction. In this study, 92% of the patients did not 21 showed that the use of femoral-sciatic nerve blocks for complex outpatients' knee surgery was associated with less postoperative pain before same-day discharge and with few hospital admissions. The use of nerve blocks for acute pain management in patients undergoing anterior cruciate ligament reconstruction is associated with post anesthesia care unit (PACU) bypass and reliable same-day discharge.…”

“…Neste estudo, 92% dos pacientes não necessitaram de morfina por via venosa nas primeiras 24 horas. Em 1.200 casos consecutivos de procedimentos cirúrgicos complexos do joelho, William e col. 21 mostraram que o uso do bloqueio dos nervos femoral-ciático foi associado com menos dor no pós-operatório antes da alta no dia do procedimento e com poucas internações hospitalares. O uso de bloqueios nervosos para o tratamento de dor aguda em pacientes submetidos à reconstrução do ligamento cruzado anterior está associado com a eliminação da necessidade de internação na unidade de recuperação pós-anestésica e alta hospitalar confiável no mesmo dia.…”

Postoperative Pain and Other Acute Pain Syndromes

“…A femoral block must often be supplemented with a single-shot or continuous sciatic nerve block for procedures such as TKA 265 or ACL reconstruction with a hamstring autograft. 154 Many randomized controlled studies that have compared UGRA, peripheral nerve stimulation, and loss-ofresistance techniques for the femoral nerve suggest that the ultrasound technique could offer faster onset of sensory loss and longer analgesia with less local anesthetic volume. [266][267][268] In the late 1990s, two studies from Europe examined rehabilitation outcomes after total knee replacement when a continuous femoral block (CFB) was used.…”

Postoperative Pain and Other Acute Pain Syndromes

“…[88][89][90] Volatile agents have also been associated with increased incidence of postoperative pain and unplanned admission (e.g., after invasive outpatient orthopedic surgery). [91][92][93][94][95] Awareness and routine implementation of peripheral multimodal analgesic techniques will likely lead to the increase of patient eligibility for same-day discharge and/or length-of-stay reduction. In addition, other effi ciencies can be gained when postoperative multimodal peripheral analgesia and systematic avoidance of GAassociated side effects are implemented as a comprehensive anesthesia care plan.…”

“…91,105 In addition, use of RA results in bypass of "phase 1" recovery (postanesthesia care unit [PACU] bypass). [91][92][93][94] Hospital cost savings appear to be achievable when PACU bypass, sameday discharge, and length-of-stay criteria are standardized and uniformly applied. 94,105-108 RA techniques are important in facilitating cost savings in ambulatory surgery, because GA techniques (including airway devices, volatile agents, and opioids, without RA use) do not reduce postoperative nursing workload when PACU bypass criteria are used.…”