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

McNamee, David; Parks, L.; Milligan, K. R.

doi:10.1034/j.1399-6576.2002.460117.x

Cited by 136 publications

(87 citation statements)

References 9 publications

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“…Nevertheless, diminished muscle control, nerve damage, and local infection are recognized complications, ranging from 0.1% to 2.5% [7,14,15,23], and 15% of femoral nerve blocks are unsuccessful [20]. PAI offers the benefits of blocking pain influx at its origin and maximizing muscle control.…”

Section: Discussionmentioning

confidence: 99%

“…First, we compared our PAI protocol with a single nerve block. To cover all the sensitive areas of the knee, it may be necessary to obstruct the sciatic, femoral, and obturator nerves [20]. Our decision to block only the femoral nerve was made to compare the PAI procedure with the most common practice in our area.…”

Section: Discussionmentioning

confidence: 99%

“…These results confirm that the sensitive sciatic nerve territory of the knee is not covered by a femoral nerve block alone. To encompass entire knee territories, lumbar plexus block [18], or femoral [9], sciatic [4], and obturator block could be combined [20]. However, a combination of these procedures adds complexity to patient care.…”

Section: Discussionmentioning

confidence: 99%

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Periarticular Injection in Knee Arthroplasty Improves Quadriceps Function

Chaumeron

Audy

Drolet

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background The postoperative analgesic potential of periarticular anesthetic infiltration (PAI) after TKA is unclear as are the complications of continuous femoral nerve block on quadriceps function. Questions/purposes We asked (1) whether PAI provides equal or improved postoperative pain control in comparison to a femoral nerve block in patients who have undergone TKA; and (2) if so, whether PAI improves early postoperative quadriceps control and facilitates rehabilitation. Methods We randomized 60 patients to receive either PAI or femoral nerve block. During the first 5 days after TKA, we compared narcotic consumption, pain control, quadriceps function, walking distance, knee ROM, capacity to perform a straight leg raise, and active knee extension. Medication-related side effects, complications, operating room time, and hospitalization duration were compared.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Periarticular Injection in Knee Arthroplasty Improves Quadriceps Function

Chaumeron

Audy

Drolet

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…Recientemente han surgido estudios en los que se combinan los bloqueos del nervio ciático 105-107 y obturador 108,109 junto al bloqueo femoral, para ver si se consigue una mejor analgesia que con el bloqueo femoral solo, sin poder recomendarse actualmente estos dos bloqueos (recomendación D, evidencia 4), por haber una gran inconsistencia entre los resultados obtenidos.…”

Section: Analgesia Epiduralunclassified

Eficacia analgésica de una dosis única de dexametasona perineural en el bloqueo ecoguiado del nervio femoral en cirugía de prótesis total de rodilla

Morales-Muñoz

Sánchez-Ramos

Díaz-Lara

et al. 2017

Revista Española de Anestesiología y Reanimación

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“…This was clinically important only in one patient (6%), suggesting that the routine block of this nerve is not necessary. MacNamee et al 26 achieved more prolonged analgesia and reduce consumption of morphine in the group of 30 patients in which obturator nerve block was associated with femoral and Vol. sciatic nerve block, all of them with a single dose, when compared with the group (n = 30) without this association.…”

Section: Discussionmentioning

confidence: 99%

Controle da dor pós-operatória da artroplastia total do joelho: é necessário associar o bloqueio do nervo isquiático ao bloqueio do nervo femoral?

Zugliani

Verçosa

Amaral

et al. 2007

Rev. Bras. Anestesiol.

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JUSTIFICATIVA E OBJETIVOS:A artroplastia total do joelho (ATJ) promove grande trauma tecidual, produzindo intensa dor no pós-operatório. A analgesia pós-operatória de boa qualidade é fundamental, devendo-se considerar que a mobilização articular precoce é um importante aspecto para obtenção de bons resultados. Há controvérsias na literatura sobre a eficácia do bloqueio isolado do nervo femoral. O objetivo deste estudo foi avaliar a analgesia pós-operatória com a associação do bloqueio dos nervos isquiático e femoral. MÉTODO:Foram estudados 17 pacientes submetidos à ATJ sob raquianestesia, divididos em dois grupos: A e B. No Grupo A (n = 9) foi realizado bloqueio do nervo femoral e no Grupo B (n = 8), bloqueio dos nervos femoral e isquiático. Os bloqueios foram realizados no pós-operatório imediato utilizando-se 20 mL de ropivacaína a 0,5% em cada um. A dor foi aferida nas primeiras 24 horas pela Escala Analógica Visual e escala verbal. Foi observado o tempo decorrido entre os bloqueios e a primeira queixa de dor (M1). RESULTADOS:A mediana do tempo de analgesia (M1) no Grupo A foi de 110 min. e no Grupo B de 1.285 min. (p = 0,0001). Não foram observadas complicações atribuíveis às técnicas utilizadas.CONCLUSÃO: O bloqueio do nervo isquiático, quando associado ao bloqueio do nervo femoral, nas condições deste estudo, melhorou de maneira significativa a qualidade da analgesia pós-operatória da ATJ.Unitermos: ANALGESIA: pós-operatória; CIRURGIA, Ortopédica: artroplastia total de joelho; TÉCNICAS ANESTÉSICAS, Regional: bloqueio do nervo femoral, bloqueio do nervo isquiático. Good postoperative analgesia is fundamental and one should consider that early mobilization of the joint is an important aspect to obtain good results. There is a controversy in the literature on the efficacy of isolated femoral nerve block. The objective of this study was to evaluate postoperative analgesia with the association of sciatic and femoral nerve block. SUMMARY METHODS:Seventeen patients undergoing TKA under spinal anesthesia were divided in two groups: A and B. In Group A (n = 9), femoral nerve block was performed, while in Group B (n = 8), femoral and sciatic nerve block were done. The blockades were done in the immediate postoperative period with 20 mL of 0.5% of ropivacaine. Pain was evaluated in the first 24 hours using the Visual Analog Scale and the verbal scale. The length of time between the nerve block and the first complaint of pain (M1) was also evaluated. RESULTS:The median of the duration of analgesia (M1) in Group A was 110 min, while in Group B it was 1285 min (p = 0.0001). There were no complications related to the technique used.CONCLUSIONS: Sciatic nerve block, when associated with femoral nerve block, under the conditions of the present study, improved significantly the quality of postoperative analgesia in TKA.

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

Abstract: The addition of an obturator nerve block to femoral and sciatic blockade improved post-operative analgesia following total knee replacement.

Cited by 136 publications

References 9 publications

Periarticular Injection in Knee Arthroplasty Improves Quadriceps Function

Periarticular Injection in Knee Arthroplasty Improves Quadriceps Function

Eficacia analgésica de una dosis única de dexametasona perineural en el bloqueo ecoguiado del nervio femoral en cirugía de prótesis total de rodilla

Controle da dor pós-operatória da artroplastia total do joelho: é necessário associar o bloqueio do nervo isquiático ao bloqueio do nervo femoral?

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