Korean J Anesthesiol.  2014 Aug;67(2):90-95. 10.4097/kjae.2014.67.2.90.

Ultrasound-guided femoral and sciatic nerve blocks combined with sedoanalgesia versus spinal anesthesia in total knee arthroplasty

• Akkaya A
• Tekelioglu UY
• Demirhan A
• Ozturan KE
• Bayir H
• Kocoglu H
• Bilgi M

• KMID: 2227409
• DOI: http://doi.org/10.4097/kjae.2014.67.2.90

Abstract

BACKGROUND
Although regional anesthesia is the first choice for patients undergoing total knee arthroplasty (TKA), it may not be effective and the risk of complications is greater in patients who are obese or who have spinal deformities. We compared the success of ultrasound-guided femoral and sciatic nerve blocks with sedoanalgesia versus spinal anesthesia in unilateral TKA patients in whom spinal anesthesia was difficult.
METHODS
We enrolled 30 patients; 15 for whom spinal anesthesia was expected to be difficult were classified as the block group, and 15 received spinal anesthesia. Regional anesthesia was achieved with bupivacaine 62.5 mg and prilocaine 250 mg to the sciatic nerve, and bupivacaine 37.5 mg and prilocaine 150 mg to the femoral nerve. Bupivacaine 20 mg was administered to induce spinal anesthesia. Hemodynamic parameters, pain and sedation scores, and surgical and patient satisfaction were compared.
RESULTS
A sufficient block could not be obtained in three patients in the block group. The arterial pressure was significantly lower in the spinal group (P < 0.001), and the incidence of nausea was higher (P = 0.017) in this group. Saturation and patient satisfaction were lower in the block group (P < 0.028), while the numerical pain score (P < 0.046) and the Ramsay sedation score were higher (P = 0.007).
CONCLUSIONS
Ultrasound-guided sciatic and femoral nerve blocks combined with sedoanalgesia were an alternative anesthesia method in selected TKA patients.

Keyword

Arthroplasty; Femoral nerve; Knee; Nerve block; Sciatic nerve; Ultrasonography

MeSH Terms

Anesthesia
Anesthesia, Conduction
Anesthesia, Spinal*
Arterial Pressure
Arthroplasty*
Bupivacaine
Congenital Abnormalities
Femoral Nerve
Hemodynamics
Humans
Incidence
Knee*
Nausea
Nerve Block
Patient Satisfaction
Prilocaine
Sciatic Nerve*
Ultrasonography
Bupivacaine
Prilocaine