J Korean Orthop Assoc.  2009 Dec;44(6):586-592. 10.4055/jkoa.2009.44.6.586.

Effect of Regional Nerve Block in Total Knee Arthroplasty

• Kim JM
• Lee DY
• Koh IJ
• Kim JI
• Ra KH

• KMID: 2186283
• DOI: http://doi.org/10.4055/jkoa.2009.44.6.586

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.
CONCLUSION
Pain control with the ropivacaine regional nerve block is more effective than the lidocaine local anesthesia, and additional sciatic nerve block is a important factor for decreasing the postoperative pain after total knee arthroplasty.

Keyword

TKA; Regional nerve block; Pain

MeSH Terms

Amides
Anesthesia, Local
Arthroplasty
Catheters
Femoral Nerve
Humans
Knee
Lidocaine
Nerve Block
Obturator Nerve
Pain, Postoperative
Prospective Studies
Sciatic Nerve
Subcutaneous Tissue
Synovial Membrane
Amides
Lidocaine

Figure

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  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).

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  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).

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  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.

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