The para‐sartorial compartments (PASC) block: a new approach to the femoral triangle block for complete analgesia of the anterior knee

Porcellini, Giuseppe; Costa, Fabio; Buono, Romualdo Del; Strumia, Alessandro; Cataldo, Rita; Carassiti, M.

doi:10.1002/anr3.12165

Cited by 8 publications

(6 citation statements)

References 5 publications

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“…Moreover, AC block may be inadequate for analgesia for TKA [ 30 ]. AC block cannot achieve complete anaesthesia of the skin and subcutis in the peripatellar region, and it is ineffective for articular pain as well [ 24 ]. Compared with AC block, the blocked area produced following PP block may be larger in the peripatellar region.…”

Section: Discussionmentioning

confidence: 99%

“…Although several techniques for PP block have been reported previously, none of them can block the four nerves of the PP completely or cover the entire peripatellar region [22,23]. It was recently reported that a combination of FTB with IFCN block could cover most of the peripatellar region [24]. However, regarding pain after TKA, the lateral patellar region cannot be anaesthetized due to the inability to block the LFCN [24].…”

Section: Discussionmentioning

confidence: 99%

“…It was recently reported that a combination of FTB with IFCN block could cover most of the peripatellar region [24]. However, regarding pain after TKA, the lateral patellar region cannot be anaesthetized due to the inability to block the LFCN [24]. A volunteer study reported that AFCN block could not achieve complete anaesthesia of the incision line for TKA even combined with FTB and would even reduce maximal knee extension force [22].…”

Section: Discussionmentioning

confidence: 99%

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Motor-sparing peripatellar plexus block provides noninferior block duration and complete block area of the peripatellar region compared with femoral nerve block: a randomized, controlled, noninferiority study

Gong¹,

Zhang

et al. 2022

BMC Anesthesiol

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Background Developing adequate regional anaesthesia for knee surgeries without affecting lower limb mobilization is crucial to perioperative analgesia. However, reports in this regard are limited. We proposed a technique for ultrasound-guided peripatellar plexus (PP) block. Compared with the femoral nerve (FN) block, we hypothesized that this technique would provide a noninferior block duration and a complete cutaneous sensory block in the peripatellar region without affecting lower limb mobilization. An investigation was conducted to verify our hypothesis in cadavers and volunteers. Methods The study was designed in two parts. First, eight cadaveric lower limbs were dissected to verify the feasibility of PP block after methylene blue injection under ultrasound. Second, using a noninferiority study design, 50 healthy volunteers were randomized to receive either a PP block (PP group) or an FN block (FN group). The primary outcome was the duration of peripatellar cutaneous sensory block, with the prespecified noninferiority margin of -3.08 h; the secondary outcome was the area of peripatellar cutaneous sensory block; in addition, the number of complete anaesthesias of the incision line for total knee arthroplasty and the Bromage score 30 min after block were recorded. Results The PP was successfully dyed, whereas the FN and saphenous nerve were unstained in all cadaveric limbs. The mean difference of the block duration between the two groups was − 1.24 (95% CI, -2.81 − 0.33) h, and the lower boundary of the two-sided 95% CI was higher than the prespecified noninferiority margin (Pnoninferiority = 0.023), confirming the noninferiority of our technique over FN block. The cutaneous sensory loss covered the entire peripatellar region in the PP group. PP block achieved complete anaesthesia of the incision line used for total knee arthroplasty and a Bromage score of 0 in 25 volunteers, which differed significantly from that of volunteers who underwent FN block. Conclusion Ultrasound-guided PP block is a feasible technique. Compared with FN block, PP block provides noninferior block duration and complete blocking of the peripatellar region without affecting lower limb mobilization. Trial registration This study was registered in the Chinese Clinical Trial Register (registration no. ChiCTR2000041547, registration date 28/12/2020).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Motor-sparing peripatellar plexus block provides noninferior block duration and complete block area of the peripatellar region compared with femoral nerve block: a randomized, controlled, noninferiority study

Gong¹,

Zhang

et al. 2022

BMC Anesthesiol

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“…The adductor canal block might be a reasonable alternative, providing a predominantly sensory block with greater quadriceps strength. [ 35 , 36 ]…”

Section: Discussionmentioning

confidence: 99%

Pain Course after Total Knee Arthroplasty within a Standardized Pain Management Concept: A Prospective Observational Study

Schindler

Schmitz

Reinhard

et al. 2022

JCM

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Background: Joint replacement surgeries have been known to be some of the most painful surgical procedures. Therefore, the options for postoperative pain management are of great importance for patients undergoing total knee arthroplasty (TKA). Despite successful surgery, up to 30% of the patients are not satisfied after the operation. The aim of this study is to assess pain development within the first 4 weeks after TKA in order to gain a better understanding and detect possible influencing factors. Methods: A total of 103 patients were included in this prospective cohort study. Postoperative pain was indicated using a numeric rating scale (NRS). Furthermore, demographic data and perioperative parameters were correlated with the reported postoperative pain. Results: The evaluation of postoperative pain scores showed a constant decrease in the first postoperative week (mean NRS score of 5.8 on day 1 to a mean NRS score of 4.6 on day 8). On day 9, the pain increased again. Thereafter, a continuous decrease in pain intensity from day 10 on was noted (continuous to a mean NRS score of 3.0 on day 29). A significant association was found between postoperative pain intensity and gender, body mass index (BMI), and preoperative leg axis. Conclusions: The increasing pain score after the first postoperative week is most likely due to more intensive mobilization and physiotherapy in the rehabilitation department. Patients that were female, had a low BMI, and a preoperative valgus leg axis showed a significantly higher postoperative pain scores. Pain management should consider these results in the future to improve patient satisfaction in the postoperative course after TKA.

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“…A shift toward finding more optimal distal motor-sparing blocks is observed in the literature. A novel parasartorial compartment (PASC) block is one such promising alternative [ 22 ]. The study by Lee et al [ 12 ] found a comparable analgesic result when a continuous catheter was placed in the femoral triangle in comparison to a proximal and distal adductor canal catheter position.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Side Effect Profile of Intrathecal Morphine versus Distal Femoral Triangle Nerve Block for Analgesia following Total Knee Arthroplasty: A Randomized Trial

Janiak

Kowalczyk

Górniewski

et al. 2022

JCM

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(1) Background: The management of postoperative pain after knee replacement is an important clinical problem. The best results in the treatment of postoperative pain are obtained using multimodal therapy principles. Intrathecal morphine (ITM) and single-shot femoral nerve block (SSFNB) are practiced in the treatment of postoperative pain after knee replacement, with the most optimal methods still under debate. The aim of this study was to compare the analgesic efficacy with special consideration of selected side effects of both methods. (2) Materials and methods: Fifty-two consecutive patients undergoing knee arthroplasty surgery at the Department of Orthopedics and Traumatology of the Medical University of Warsaw were included in the study. Patients were randomly allocated to one of two groups. In the ITM group, 100 micrograms of intrathecal morphine were used, and in the SSFNB group, a femoral nerve block in the distal femoral triangle was used as postoperative analgesia. The other elements of anesthesia and surgery did not differ between the groups. (3) Results: The total dose of morphine administered in the postoperative period and the effectiveness of pain management did not differ significantly between the groups (cumulative median morphine dose in 24 h in the ITM group 31 mg vs. SSFNB group 29 mg). The incidence of nausea and pruritus in the postoperative period differed significantly in favor of patients treated with a femoral nerve block. (4) Conclusions: Although intrathecal administration of morphine is similarly effective in the treatment of pain after knee replacement surgery as a single femoral triangle nerve block, it is associated with a higher incidence of cumbersome side effects, primarily nausea and pruritus.

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The para‐sartorial compartments (PASC) block: a new approach to the femoral triangle block for complete analgesia of the anterior knee

Cited by 8 publications

References 5 publications

Motor-sparing peripatellar plexus block provides noninferior block duration and complete block area of the peripatellar region compared with femoral nerve block: a randomized, controlled, noninferiority study

Motor-sparing peripatellar plexus block provides noninferior block duration and complete block area of the peripatellar region compared with femoral nerve block: a randomized, controlled, noninferiority study

Pain Course after Total Knee Arthroplasty within a Standardized Pain Management Concept: A Prospective Observational Study

Efficacy and Side Effect Profile of Intrathecal Morphine versus Distal Femoral Triangle Nerve Block for Analgesia following Total Knee Arthroplasty: A Randomized Trial

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