The value of adding sciatic block to continuous femoral block for analgesia after total knee replacement

Dang, Charles Pham; Gautheron, Etienne; Guilley, Jérôme; Fernandez, M.; Waast, D.; Volteau, Christelle; Nguyen, Jean Michel; Pinaud, M.

doi:10.1016/j.rapm.2004.11.009

Cited by 54 publications

(14 citation statements)

References 17 publications

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“…Cook et al [16] reported that the combined femoral and sciatic nerve block provided superior pain management in the early postoperative period after TKA. Pham Dhang et al [17] performed an RCT to assess the benefit of using sciatic nerve block to improve analgesia after TKA, and suggested that the combination of continuous femoral and sciatic nerve block improved analgesia while decreasing morphine consumption and occurrence of postoperative nausea and vomiting. However, additional SNB may be associated with considerable side effects such as weakness in the quadriceps muscles, which results in an increased risk of postoperative falls.…”

Section: Discussionmentioning

confidence: 99%

Comparison of local infiltration analgesia and sciatic nerve block as an adjunct to femoral nerve block for pain control after total knee arthroplasty

2017

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Background:To perform a meta-analysis to assess the efficiency and safety between local infiltration analgesia (LIA) and sciatic nerve block (SNB) when combined with femoral nerve block (FNB) for pain control following total knee arthroplasty (TKA).Methods:We systemically searched the following electronic databases for potentially relevant articles: Embase (1980–2017.01), Medline (1966–2017.01), PubMed (1966–2017.01), ScienceDirect (1985–2017.01), web of science (1950–2017.01) and the Cochrane Library. Only studies published in English that were accessible online were considered. Furthermore, we only considered studies that were published from 1966 to 2017. Only studies that met the following inclusion criteria were considered: (a) patients were adult human subjects who were set to undergo TKA; (b) the intervention was either SNB combined with FNB or LIA combined with FNB; (c) the outcomes of the studies, such as visual analog scale (VAS) scores, morphine consumption, length of stay and postoperative adverse effects, including the risk of nausea, vomiting and falls, were reported; (d) studies were either RCTs or non-RCT. Meta-analysis was performed using Stata 11.0 software. Modified Jadad score (7-points scale) which was based on Cochrane Handbook for Systematic Reviews of Interventions is used for assessment of RCTs. The Methodological Index for Nonrandomized Studies (MINORS) scale was used to assess non-RCTs with scores ranging 0 to 24. The synthesis of the outcomes for all studies was calculated as the weighted average rate by using a fixed or random effect model which depends on statistical heterogeneity. Systematic review registration number is CRD42017110661.Results:Three randomized controlled trials (RCTs) and 2 nonrandomized controlled trials (Non-RCTs), including 240 patients met the inclusion criteria. The present meta-analysis indicated that there were significant differences between groups in terms of visual analog scale (VAS) score at 12 hours (SMD = −0.337, 95% CI: −0.593 to −0.081, P =.010), VAS score at 24 hours (SMD = −0.337, 95% CI: −0.612 to −0.061, P =.017), morphine equivalent consumption at 24 hours (SMD = −0.371, 95% CI: −0.627 to −0.114, P = .005) and incidence of nausea (RD = 0.215, 95% CI: 0.078 to 0.353, P = .002) and vomiting (RD = 0.143, 95% CI: 0.026 to 0.260, P = .017).Conclusion:FNB combined with SNB provided decreased VAS scores and less morphine consumption at 12 and 24 hours compared with FNB combined with LIA in total knee arthroplasty. In addition, it was associated with lower risks of nausea and vomiting. We assessed the quality of the evidence as low to very low; therefore, our confidence in the effect estimate is limited, and the true effect may be substantially different from our estimates. Further studies should focus on surgeries that are known to be associated with significant postoperative pain, particularly surgeries where improved pain control may deliver significant clinical benefits through reduced morbidity, or cost-effectiveness benefits through faster r...

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Section: Discussionmentioning

confidence: 99%

Comparison of local infiltration analgesia and sciatic nerve block as an adjunct to femoral nerve block for pain control after total knee arthroplasty

2017

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“…There is a consensus regarding the benefits of femoral nerve block to the patient 2,7-10 , due to its predominance in the innervation in this area. However, there is a controversy in the literature regarding the need to block the other nerves, especially the sciatic and obturator nerves, to obtain complete analgesia [11][12][13] . The objective of this study was to evaluate whether the association of sciatic nerve block with femoral nerve block is necessary to obtain good postoperative analgesia in total knee arthroplasty.…”

Section: Tabela I -Dados Antropométricosmentioning

confidence: 99%

“…Há um consenso quanto aos benefícios proporcionados ao paciente pelo bloqueio do nervo femoral 2,7-10 , devido a sua predominância no suprimento nervoso da área envolvida. Há, porém, controvérsia na literatura, quanto à necessidade do bloqueio de outros nervos, nomeadamente do isquiático e do obturatório, para obtenção de completa analgesia [11][12][13] . Este estudo teve como objetivo avaliar se é necessária a associação do bloqueio do nervo isquiático ao bloqueio do nervo femoral para obtenção de analgesia pós-operatória de boa qualidade da artroplastia total do joelho.…”

Section: Introductionunclassified

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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“…Two kinds of peripheral nerve block have been suggested to improve analgesia following TKA in combination with FNB; obturator nerve block5,6 and sciatic nerve block 7–9. However, no investigations have directly compared these two methods of analgesia.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound Guided Obturator versus Sciatic Nerve Block in Addition to Continuous Femoral Nerve Block for Analgesia after Total Knee Arthroplasty

et al. 2011

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Both obturator and sciatic nerve block in combination with femoral nerve block (FNB) have been suggested to be useful in relieving pain after total knee arthroplasty (TKA), compared with FNB alone. We compared their efficacy in this retrospective study. For six consecutive months, patients undergoing unilateral TKA under general anesthesia with continuous FNB plus obturator nerve block (n = 8) or continuous FNB plus sciatic nerve block (n = 8) were investigated. Knee pain was assessed using visual analogue scale (VAS) on the day of surgery and on postoperative days one to three. In addition, we also investigated intraoperative and postoperative morphine consumption. VAS scores and total morphine consumption were not different between the two groups, although patients in the FNB plus sciatic nerve block group were administered less morphine during surgery. Sciatic nerve block with continuous FNB may be superior to obturator nerve block with continuous FNB for analgesia during surgery for TKA.

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The value of adding sciatic block to continuous femoral block for analgesia after total knee replacement

Abstract: During the 36 hours immediately after total knee replacement, the combination of continuous femoral and sciatic nerve blocks improves analgesia while decreasing morphine consumption and PONV.

Cited by 54 publications

References 17 publications

Comparison of local infiltration analgesia and sciatic nerve block as an adjunct to femoral nerve block for pain control after total knee arthroplasty

Comparison of local infiltration analgesia and sciatic nerve block as an adjunct to femoral nerve block for pain control after total knee arthroplasty

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

Ultrasound Guided Obturator versus Sciatic Nerve Block in Addition to Continuous Femoral Nerve Block for Analgesia after Total Knee Arthroplasty

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