Is sciatic nerve block advantageous when combined with femoral nerve block for postoperative analgesia following total knee arthroplasty? a meta-analysis

Narrowing the blockade field: development of an optimal postoperative analgesia regimen for total knee arthroplasty

“…In this issue, Abdallah et al discuss their meta-analysis of several recent randomized-controlled trials, which they performed in an attempt to address the effectiveness of a combined FNB and SNB approach. 3 The authors show that, although individual studies provide mixed results, overall trends suggest that combining SNB and FNB can reduce opioid consumption and alleviate knee pain postoperatively compared with FNB alone.…”

“…Nevertheless, Abdallah et al found that the addition of SNB did not significantly delay functional recovery or discharge from hospital. 3 This finding suggests that the FNB alone can be responsible for the motor impairment that precludes early mobilization and that its effects eclipse any effects of the SNB that would impede early mobilization.…”

“…In this issue, Abdallah et al discuss their meta-analysis of several recent randomized-controlled trials, which they performed in an attempt to address the effectiveness of a combined FNB and SNB approach. 3 The authors show that, although individual studies provide mixed results, overall trends suggest that combining SNB and FNB can reduce opioid consumption and alleviate knee pain postoperatively compared with FNB alone.As Gaston Labat, the father of modern regional anesthesia, stated in his classic textbook, ''Anatomy is the foundation upon which the entire concept of regional anesthesia is built.'' 4 Thus, a comprehensive understanding of anatomy is critical in order to select the appropriate block for the procedure and to provide effective analgesia.…”

“…The evidence in favour of SNB for TKA analgesia is relatively strong (grade A 12 recommendation), although the considerable heterogeneity among the studies analyzed by Abdallah et al limits the strength of their analysis. 3 Moreover, as acknowledged in the review, most individuals have trouble discerning pain in regions of the knee supplied by different nerves (e.g., femoral for the anterior knee, sciatic for the posterior) since the nerves have overlapping distributions in this area. Nevertheless, we must remain cognizant of the fact that, along with offering supplemental analgesia, SNB may produce significant weakness 1 of the lower calf and/or cause foot drop, further complicating the goal of early rehabilitation.…”

“…La prise en charge de la douleur pour l'ATG est complexe et, même en réalisant plusieurs blocs nerveux, on ne parvient pas toujours à 3 Les auteurs montrent que, bien que les études individuelles présentent des résultats mitigés, les tendances globales laissent à penser que la combinaison de ces deux blocs pourrait réduire la consommation d'opioïdes et soulager la douleur postopératoire au genou, comparativement à une technique de BNF seul.…”