Epidural analgesia versus femoral or femoral-sciatic nerve block after total knee replacement: comparison of efficacy and safety

• Published in: Revista española de anestesiología y reanimación Vol. 56; no. 1; p. 16
• Main Authors: Santiveri Papiol, X, Castillo Monsegur, J, Bisbe Vives, E, Ginés Cespedosa, A, Bartrons Vilarnau, R, Montes Pérez, A, Escolano Villén, F
• Format: Journal Article
• Language: Spanish
• Published: Spain 01.01.2009
• Subjects: Aged; Aged, 80 and over; Analgesia, Epidural - adverse effects; Analgesia, Epidural - statistics & numerical data; Anesthetics, Local - administration & dosage; Anesthetics, Local - therapeutic use; Arthroplasty, Replacement, Knee; Bupivacaine - administration & dosage; Bupivacaine - therapeutic use; Female; Femoral Nerve; Humans; Male; Middle Aged; Morphine - therapeutic use; Narcotics - therapeutic use; Nerve Block - adverse effects; Nerve Block - methods; Pain Measurement; Pain, Postoperative - drug therapy; Postoperative Nausea and Vomiting - chemically induced; Prospective Studies; Sciatic Nerve; Urinary Retention - chemically induced
• ISSN: 0034-9356
• DOI: 10.1016/S0034-9356(09)70315-9

Pain after total knee replacement surgery is intense. The aim of this study was to compare 3 techniques for providing postoperative analgesia (epidural analgesia, femoral nerve block, and a combined femoral-sciatic nerve block) in total knee arthroplasty. Observational study of 1550 elective primary unilateral total knee replacement operations. The safety and efficacy of the following 3 techniques were compared: epidural analgesia, femoral nerve block, and femoral-sciatic nerve block. Demographic, anesthetic, and surgical data were recorded. Study variables included pain intensity on a visual analog scale every 4 hours, need for rescue analgesia (morphine), complications and adverse events within 5 postoperative days. No significant differences were found in demographic, anesthetic, or surgical variables. In the first 24 hours after surgery, pain intensity was significantly less for patients who received a femoral-sciatic nerve block. The mean levels of morphine consumption in the first 96 hours after surgery were similar in the femoral-sciatic nerve block group (3.18 mg) and the epidural analgesia group (3.19 mg); morphine consumption in the femoral block group was significantly higher (4.51 mg). Epidural analgesia was associated with the highest rate of complications (17%). A sciatic nerve block combined with a femoral nerve block attenuates pain more effectively and is associated with less postoperative morphine consumption in comparison with a femoral nerve block alone. Peripheral nerve block techniques have fewer adverse side effects than epidural analgesia.