Motor-Sparing Peripheral Nerve Blocks for Shoulder, Knee, and Hip Surgery

Layera, Sebastián; Saadawi, Mohammed; Tran, De Q.H.; Salinas, Francis V.

doi:10.1016/j.aan.2020.08.003

Cited by 8 publications

(10 citation statements)

References 83 publications

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“…Figure 2 demonstrates results after a hip surgery. Use of WPD resulted in significantly reduced median averaged NRS values at rest, compared to Epi and Pir (0.75 [IQR 1.14] vs. 1.17 [1.5] Age (years) 68 [18] 69 [29] 67 [17] Height (cm) 169 [14] 170 [13] 168 [16] Weight (kg) No significant differences were found between primary and revision hip surgery in the WPD group (as the mostly used procedure) for any of the parameters analyzed. Figure 3 shows the results after knee surgery.…”

Section: Resultsmentioning

confidence: 99%

“…The latter may be used in exceptional cases, e.g., excessive chronic opioid use or the need for intensified physiotherapy due to pathologic stiffening following arthroplasty. However, a wellorganized acute pain service is required to identify and to manage unwanted side effects and technical problems as early as possible, as underlined by the results on PNB described by Chelly et al Recent data suggest that newly introduced nerve blocks (i.e., quadratus lumborum [QLB] or pericapsular nerve group [PENG] block) potentially motor sparing may be a promising alternative, but evidence from larger-cohort studies is still missing [17].…”

Section: Discussionmentioning

confidence: 99%

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Pain levels and patient comfort after lower limb arthroplasty comparing i.v. patient-controlled analgesia, continuous peripheral nerve block and neuraxial analgesia: a retrospective cohort analysis of clinical routine data

et al. 2022

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Background Insufficient pain control after lower limb arthroplasty results in delayed recovery and increased risk for pain chronicization. The ideal kind of analgesia is still discussed controversially. We conducted a retrospective analysis of single-center routine data from a German university hospital, including patients receiving either total hip (THA) or knee arthroplasty (TKA). Methods All patients received general anesthesia. Patients undergoing THA received either continuous epidural ropivacaine infusion (0.133%, Epi) or patient-controlled analgesia (PCA) with the Wurzburg Pain Drip (tramadol, metamizole and droperidol, WPD) or with piritramide (Pir). After TKA, patients received either continuous femoral nerve block (ropivacaine 0.2%, PNB) or Pir. Results The analyzed cohort comprised 769 cases. Use of WPD after THA (n = 333) resulted in significantly reduced Numeric Rating Scale (NRS) values at rest, compared to Epi (n = 48) and Pir (n = 72) (.75 [IQR 1.14] vs. 1.17 [1.5], p = .02 vs. 1.47 [1.33], p < .0001) as well as maximum NRS scores (2.4 [1.7] vs. 3.29 [1.94], p < .001 vs. 3.32 [1.76], p < .0001). Positive feedback during follow-up visits was significantly increased in patients with a WPD PCA (p < .0001), while negative feedback (senso-motoric weakness/technical problems/nausea/dizziness/constipation) was particularly increased in Epi patients and lowest in those with WPD (p < .0001). After TKA, Pir (n = 131) resulted in significantly reduced NRS values at rest, compared to PNB (n = 185) (1.4 [1.4] vs. 1.6 [1.68], p = .02). Positive feedback was increased in patients with a Pir PCA in comparison with PNB (p = .04), while negative feedback was increased in PNB patients (p = .04). Overall, WPD presented with the lowest rate of any complications (8.7%), followed by Pir (20.2%), PNB (27.6%) and Epi (31.3%) (p < .001). Conclusions In the assessed population, the use of a WPD PCA after THA offered better pain control and patient comfort in comparison with continuous epidural or piritramide-based analgesia. After TKA, the use of a Pir PCA provided superior analgesia and a lower complication rate compared to continuous PNB.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pain levels and patient comfort after lower limb arthroplasty comparing i.v. patient-controlled analgesia, continuous peripheral nerve block and neuraxial analgesia: a retrospective cohort analysis of clinical routine data

et al. 2022

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“…Compared with the ACB, the FTB can affect more afferent branches of the FN [ 22 ], Like the SN, the vastus medialis nerve (VMN), the MFCN. The VMN and its terminal branches contain the sensory fibers of the knee joint [ 11 , 12 ]. the muscular branch outlet of the VMN is now below the mid-thigh, this anatomical feature provides a theoretical basis for the FTB to minimize quadriceps weakness and maximize its analgesic effect [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…In the coronal plane, the proximal FT consists of the inguinal ligament, the lateral side consists of the medial side of the sartorius muscle, the medial side consists of the lateral side of the adductor longus muscle, and the junction of the sartorius and adductor longus was defined as the apex of the FT. The AC is a myofascial compartment in the middle and lower thigh that extends from the apex of the FT to the adductor hiatus [ 11 ]. The nerves distributed in the two areas are different.…”

Section: Introductionmentioning

confidence: 99%

Application of ultrasound-guided single femoral triangle and adductor canal block in arthroscopic knee surgery: a prospective, double-blind, randomized clinical study

Chen,

Tan,

et al. 2024

BMC Anesthesiol

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Purpose To compare the difference in analgesic effect between femoral triangle block (FTB) and adductor canal block (ACB) during arthroscopic knee surgery. Methods Patients who underwent arthroscopic knee surgery were randomized preoperatively to FTB group or ACB group. For each group, 20 mL of 0.1% ropivacaine was injected. Primary outcomes: The numeric rating score (NRS) at 12 h after surgery at rest and during movement. Secondary outcome: (1) The NRS at post anesthesia care unit (PACU) and 2, 24 h after surgery at rest and during movement; (2) The quadriceps muscle strength at PACU and 2, 12, 24 h after surgery; (3) Consumption of Rescue analgesia; (4) Incidence of adverse reactions. Results The NRS at 12 h after surgery at rest and during movement of ACB group were higher than FTB group. Among secondary outcomes, the NRS at PACU at rest and during movement, 2 h after surgery during movement of FTB group lower than ACB group; the quadriceps muscle strength at 2 h after surgery of FTB group stronger than ACB group. After multiple linear regression model analysis, the data showed additional statistically significant reduction NRS at 24 h after surgery at rest (0.757, p = 0.037) in FTB group. Other outcomes were similar between two groups. Conclusions The FTB appears to provide superior pain control after knee arthroscopy than ACB, the FTB is superior to the ACB in quadriceps muscle strength at 2 h after surgery. Trial registration The trial was registered in the Chinese Clinical Trial Registry (ChiCTR2300068765). Registration date: 28/02/2023.

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“…Periarticular local anesthesia infiltration (PAI) or peripheral nerve blocks are frequently included in perioperative analgesic protocols. Ideally, the latter should provide analgesia while minimizing motor block 3 , although lumbar plexus, fascia iliaca, and femoral nerve blocks are commonly performed for hip surgery, they inevitably result in motor weakness of the lower limb since they target the femoral nerve and the obturator nerve 3,4 .…”

Section: Introductionmentioning

confidence: 99%

Untitled

2023

J Anesthesiol & Pain Therapy

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Study Objective: This narrative review discusses the anatomy, mechanism of action, techniques, indications and complications of the pericapsular nerve group block in a hip surgery setting. Interventions:The MEDLINE, EMBASE and Google Scholar databases (inception to the first week of March 2023) were searched. For anatomy, mechanism of action, techniques, and complications, cadaveric research, randomized trials, retrospective studies and case series were considered. Nonetheless, for surgery indications, to highlight the best evidence available, only randomized trials without major discrepancies with their prospective registration, blinded assessment and sample size justification were retained for analysis. Main Results:The anatomical studies suggest that pericapsular nerve group block may work through a combination of different mechanisms (i.e., blocking lateral capsule nerves, local anesthetic spread to the femoral nerve, spread towards medial capsule nerves). Compared to alternatives, except for the periarticular local anesthetic infiltration, pericapsular nerves group block results in similar or improved postoperative analgesia in total hip arthroplasty. It should be noted that the motor blockade has not been completely circumvented and the scarcity of adequate studies on other surgical procedures prevents from obtaining further conclusions about its indications. Conclusions:The pericapsular nerve group block has become very popular after its first description as an analgesic motor-sparing technique for hip fractures. However, without an absolute motor-sparing effect, its current indication is better supported in postoperative analgesia for total hip arthroplasty. Therefore, further investigation is required to find the optimal motor-sparing analgesic block for hip surgery. AbbreviationsAIIS= anteroinferior iliac spine; AON= accessory obturator nerve; FN= femoral nerve; FNB= femoral nerve block; IAI= intraarticular injection; IM= Iliacus muscle; ImM= iliacus minor muscle; IPE= iliopubic eminence; IPB= iliopsoas plane block; IPM= iliopsoas muscle; IPP iliopsoas plane=; IPT= iliopsoas tendon; LA= local anesthetic; LFCN= lateral femoral cutaneous nerve; ON= obturator nerve; PAI= periarticular local anesthetic infiltration; PACU= postanesthetic care unit; PeM= pectineus muscle; PENG= pericapsular nerve group; PMM= psoas major muscle; PPI= periportal local anesthetic infiltration; POD= postoperative day; RCT= randomized controlled trial; SIFIB= suprainguinal fascia iliaca block; THA = total hip arthroplasty; USG = ultrasound-guided; WI= wound local anesthetic infiltration.

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Motor-Sparing Peripheral Nerve Blocks for Shoulder, Knee, and Hip Surgery

Cited by 8 publications

References 83 publications

Pain levels and patient comfort after lower limb arthroplasty comparing i.v. patient-controlled analgesia, continuous peripheral nerve block and neuraxial analgesia: a retrospective cohort analysis of clinical routine data

Pain levels and patient comfort after lower limb arthroplasty comparing i.v. patient-controlled analgesia, continuous peripheral nerve block and neuraxial analgesia: a retrospective cohort analysis of clinical routine data

Application of ultrasound-guided single femoral triangle and adductor canal block in arthroscopic knee surgery: a prospective, double-blind, randomized clinical study

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