Korean J Anesthesiol.  2012 May;62(5):448-453. 10.4097/kjae.2012.62.5.448.

A comparison of femoral/sciatic nerve block with lateral femoral cutaneous nerve block and combined spinal epidural anesthesia for total knee replacement arthroplasty

• Kim JH
• Cho MR
• Kim SO
• Kim JE
• Lee DK
• Roh WS

• KMID: 2243824
• DOI: http://doi.org/10.4097/kjae.2012.62.5.448

Abstract

BACKGROUND
Several factors, such as compromised cardiopulmonary function, anticoagulative therapy, or anatomical deformity in the elderly, prevent general anesthesia and neuraxial blockade from being conducted for total knee replacement arthroplasty (TKRA). We investigated the efficacy of femoral/sciatic nerve block with lateral femoral cutaneous nerve block (FSNB) as an alternative procedure in comparison with combined spinal epidural nerve block (CSE) in patients undergoing TKRA.
METHODS
In this observational study, 80 American Society of Anesthesiologists physical status I-III patients scheduled for elective unilateral TKRA underwent CSE (n = 40) or FSNB (n = 40). Perioperative side effects, intraoperative medications, duration and remaining amount of intravenous patient-controlled analgesia, rate of satisfaction with the surgical anesthesia and postoperative analgesia, willingness to recommend the same surgical anesthesia and postoperative analgesia to others, and postoperative visual analog scale pain scores were assessed. Statistical analysis was done using Chi-square test, Student's t-test, and repeated-measures analysis of variances.
RESULTS
There was significantly more use of antihypertensives, analgesics, and sedatives in the FSNB group. There were no significant differences of perioperative side effects, duration and remaining amount of intravenous patient-controlled analgesia, rate of satisfaction with the surgical anesthesia and postoperative analgesia, willingness to recommend the same surgical anesthesia and postoperative analgesia to others, and postoperative visual analog scale scores between the two groups.
CONCLUSIONS
FSNB with a sophisticated use of antihypertensives, analgesics, and sedatives to supplement insufficient block offers a practical alternative to CSE for TKRAs.

Keyword

Epidural anesthesia; Femoral nerve; Nerve block; Sciatic nerve; Spinal anesthesia; Total knee replacement

MeSH Terms

Aged
Analgesia
Analgesia, Patient-Controlled
Analgesics
Anesthesia
Anesthesia, Epidural
Anesthesia, General
Anesthesia, Spinal
Antihypertensive Agents
Arthroplasty
Arthroplasty, Replacement, Knee
Congenital Abnormalities
Femoral Nerve
Humans
Hypnotics and Sedatives
Nerve Block
Sciatic Nerve
Analgesics
Antihypertensive Agents
Hypnotics and Sedatives