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Abstract
Purpose
The goal of this study is to evaluate the efficacy of femoral, obturator, and sciatic nerve regional blocks with using ropivacaine during total knee arthroplasty.
Materials and Methods
As a prospective study, we performed total knee arthroplasty for 383 patients from Oct. 2004 to Feb. 2009. There was 139 cases of femoral and obturator nerve regional block, 123 cases of femoral, obturator, and sciatic nerve regional block, and 121 cases of lidocaine local anesthesia at the synovium and subcutaneous tissue during wound closure. All the femoral nerve block cases used a femoral catheter for an additional ropivacaine injection at 10 hours after surgery. The pain was examined using a visual analogue scale (VAS). The VAS scores were checked on the day of surgery and at post operative 24 hours, 48 hours and 6 days. The pain control effects among the 3 groups were compared with one-way ANOVA test and Scheffe`s multiple comparison test.
Results
The mean postoperative VAS score on the day of surgery and at post operative 24 hours, 48 hours and 6 days in the femoral and obturator nerve block group, were 6.3, 5.6, 5.3, and 4.7, respectively. For the cases of femoral, obturator and sciatic nerve block, the VAS scores were 3.9, 4.3, 3.5 and 1.9, respectively, and the VAS scores in the lidocaine local anesthetic group were 7.1, 6.1, 5.8 and 5.2, respectively. There was a statistical significance in all three groups (p<.0001), and the additional sciatic nerve block groups had significant effectiveness.
Figures and Tables
Fig. 1
Regional nerve block was carried out at the obturator (A) and femoral nerve (B). Sutures used to hold retention catheter in situ (C).
Fig. 2
The injection site and Raj method of sciatic nerve block is midpoint between ischial tuberosity and greater trochanter (A and B). 20 ml of 0.375% ropivacaine was injected (C).
Fig. 3
Comparison of VAS after surgery according to operation days shows the sciatic nerve block in addition to the obturator and femoral nerve block was superior to the other groups.
References
1. Mahoney OM, Noble PC, Davidson J, Tullos HS. The effect of continuous epidural analgesia on postoperative pain, rehabilitation, and duration of hospitalization in total knee arthroplasty. Clin Orthop Relat Res. 1990. 260:30–37.
2. Duggan J, Drummond GB. Activity of lower intercostal and abdominal muscle after upper abdominal surgery. . Anesth Analg. 1987. 66:852–855.
3. Miller RD. Anesthesia. 2004. 4th ed. New York: Churchill Livingstone;417–487.
4. Rutberg H, Håkanson E, Anderberg B, Jorfeldt L, Mårtensson J, Schildt B. Effects of the extradural administration of morphine, or bupivacaine, on the endocrine response to upper abdominal surgery. Br J Anaesth. 1984. 56:233–238.
5. Raj PP, Parks RI, Watson TD, Jenkins MT. A new single-position supine approach to sciatic-femoral nerve block. Anesth Analg. 1975. 54:489–493.
6. Flandry F, Hunt JP, Terry GC, Hughston JC. Analysis of subjective knee complaints using visual analog scales. Am J Sports Med. 1991. 19:112–118.
7. Weddel SJ, Ritter RR. Serum levels following epidural administration of morphine and correlation with relief of postsurgical pain. Anesthesiology. 1981. 54:210–214.
8. Singelyn FJ, Deyaert M, Joris D, Pendeville E, Gouverneur JM. Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous three-in-one block on postoperative pain and knee rehabilitation after unilateral total knee arthroplasty. Anesth Analg. 1998. 87:88–92.
9. Chelly JE, Greger J, Gebhard R, et al. Continuous femoral blocks improve recovery and outcome of patients undergoing total knee arthroplasty. J Arthroplasty. 2001. 16:436–445.
10. Capdevila X, Barthelet Y, Biboulet P, Ryckwaert Y, Rubenovitch J, d'Athis F. Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery. Anesthesiology. 1999. 91:8–15.
11. Feldman HS, Covino BG. Comparative motor-blocking effects of bupivacaine and ropivacaine, a new amino amide local anesthetic, in the rat and dog. Anesth Analg. 1988. 67:1047–1052.
12. Scott DB, Lee A, Fagan D, Bowler GM, Bloomfield P, Lundh R. Acute toxicity of ropivacaine compared with that of bupivacaine. Anesth Analg. 1989. 69:563–569.
13. Parvataneni HK, Shah VP, Howard H, Cole N, Ranawat AS, Ranawat CS. Controlling pain after total hip and knee arthroplasty using a multimodal protocol with local periarticular injections: a prospective randomized study. J Arthroplasty. 2007. 22:6 Suppl 2. 33–38.
14. Barrington MJ, Olive D, Low K, Scott DA, Brittain J, Choong P. Continuous femoral nerve blockade or epidural analgesia after total knee replacement: a prospective randomized controlled trial. Anesth Analg. 2005. 101:1824–1829.
15. Hayek SM, Ritchey RM, Sessler D, et al. Continuous femoral nerve analgesia after unilateral total knee arthroplasty: stimulating versus nonstimulating catheters. Anesth Analg. 2006. 103:1565–1570.
16. Shum CF, Lo NN, Yeo SJ, Yang KY, Chong HC, Yeo SN. Continuous femoral nerve block in total knee arthroplasty: immediate and two-year outcomes. J Arthroplasty. 2009. 24:204–209.
17. Winnie AP, Ramamurthy S, Durrani Z. The inguinal paravascular technic of lumbar plexus anesthesia: the "3-in-1 block". Anesth Analg. 1973. 52:989–996.
18. Ritter JW. Femoral nerve "sheath" for inguinal paravascular lumbar plexus block is not found in human cadavers. J Clin Anesth. 1995. 7:470–473.
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