Efficacy of Sciatic Nerve Block for Pain Management in below Knee Orthopaedic Surgery (original) (raw)
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Journal of Pharmacy and Pharmacology 6 (2018) 760-764, 2018
Total knee arthroplasty (TKA) can contribute to significant pain for the patient. Continuous peripheral nerve blocks (CPNBs) have been shown to be efficacious in treating post-surgical pain. The objective of this study is to determine the efficacy of a bupivacaine 0.2% solution administered via CPNB plus standard of care (SOC) compared to SOC alone. SOC for this institution includes the use of opioid analgesics, non-opioid analgesics, regional anesthesia, and other adjuncts. The primary outcome is the overall use of post-operative pain medication. Secondary outcomes include the average length of stay and average pain scores. Methods: A data surveillance system was used to retrospectively identify all patients who underwent TKA with and without the use of CPNB. To be included, patients must have been male or female ≥ 18 years of age who underwent TKA from September 2016 through September 2017. And 70 patients were included in both the CPNB and SOC groups. A retrospective chart review determined the following data: The types and amounts of pain medications used, the length of stay, and patient-reported pain scores. Results: There was an increase in the amount of as needed pain medication use in the CPNB + SOC vs. SOC group with 12.97 administrations vs. 12.67 administrations respectively. Length of stay was increased in the CPNB + SOC vs. SOC group with 3.65 days in the CPNB + SOC group vs. 3.5 days in the SOC group. Pain scores were increased in the CPNB + SOC group with a patient average pain score of 4.5 vs. the SOC groups average pain score of 4.4. Conclusions: The use of a 0.2% bupivacaine solution administered via CPNB in addition to SOC resulted in increased utilization of as needed pain medication administration, increased average length of stay, and increased average pain scores when compared to SOC alone.
Journal of Evolution of Medical and Dental Sciences
BACKGROUND Femoral Nerve Block (FNB) and Lateral Femoral Cutaneous Nerve Block (LFCNB) are easy to perform, have high success rates, have fewer complications and have significant clinical applicability for post-operative pain management in surgeries on the anterior thigh, knee and quadriceps tendon repair. We compared the efficacy of 0.5% Ropivacaine and 0.5% Bupivacaine in combined femoral and lateral femoral cutaneous nerve block on the duration of postoperative analgesia in knee and above knee surgeries. MATERIALS AND METHODS 90 patients of ASA grade I and II who underwent knee and above knee surgeries of lower limb were included in this study. These patients were divided in to three groups (n=30 each) according to the study drugs. Group N (Normal Saline), Group R (0.5% Ropivacaine), and Group B (0.5% Bupivacaine). Each patient received a fixed volume of study drugs: 15 ml for FNB and 8 ml for LFCNB. The patients were observed for Time of Onset of Analgesia (TOA), Duration of Analgesia (DOA), Assessment of Severity and Time of Post-Operative Pain. RESULTS Onset of action was faster with Ropivacaine as compared to Bupivacaine (p=0.001) (Group R<B<N). Duration of analgesia was longer (Group R>B>N) in Ropivacaine group than Bupivacaine (p=0.001). VAS>3 was observed at 7.13 ± 1.01 hrs., 15.06 ± 1.72 hrs. and 11.33 ± 1.52 hrs. in group N, R and B respectively (p<0.05). CONCLUSION Combined Femoral Nerve Block and Lateral Femoral Cutaneous Nerve Block with Ropivacaine provides early onset, prolonged duration and better relief in post-operative pain with minimal adverse effects as compared to Bupivacaine in knee and above knee surgeries.
Anesthesia and analgesia, 2006
Epidural analgesia remains the "gold standard" of pain relief after total knee replacement. However, peripheral nerve block is gaining popularity because the incidence of side effects may be reduced. Our study tests this postulate. Sixty patients were prospectively randomized to receive either epidural infusion or combined continuous femoral and sciatic nerve blocks. Ropivacaine 2 mg/mL plus sufentanil 1 g/mL was given either epidurally or through the femoral nerve catheter, and ropivacaine 0.5 mg/mL was given through the sciatic nerve catheter using elastomeric infusers (delivering 5 mL/h for 55 h). The primary outcome measure was the total incidence of side effects (urinary retention and moderate to severe degrees of dizziness, pruritus, sedation, and nausea/vomiting on the first postoperative day). Intensity of motor blockade, pain at rest and on mobilization, and rehabilitation indices were also registered for 72 h. One or more side effects were present in 87% of patients in the epidural group whereas only 35% of patients in the femoral and sciatic block groups were affected on the first postoperative day (P ϭ 0.0002). Motor blockade was more intense in the operated limb on the day of surgery and the first postoperative day in the peripheral nerve block group (P ϭ 0.001), whereas the non-operated limb was more blocked in the epidural group on the day of surgery (P ϭ 0.0003). Pain on mobilization was well controlled in both groups and there were no differences in the length of hospital stay. Rehabilitation indices were similar. The results demonstrate a reduced incidence of side effects in the femoral/ sciatic nerve block group than in the epidural group on the first postoperative day. (Anesth Analg 2006;102:1240 -6) E pidural infusion of a local anesthetic with an opiate is a well established analgesia regimen after total knee replacement (TKR) (1,2), providing better pain control than patient-controlled analgesia (PCA) with morphine (3). There are, however, frequent side effects such as urinary retention, dizziness, sedation, pruritus, nausea, vomiting, catheter displacement, or the spread of analgesia to the nonoperated limb (4,5). Lorenzini et al. (4) report that 68% of patients receiving a combination of ropivacaine 2 mg/mL and sufentanil 1 g/mL had nausea/ vomiting, 66% had urinary retention, and 58% had pruritus after 24 h of epidural infusion. Thus, the optimal analgesic technique that does not hinder mobilization and delay rehabilitation after TKR remains undetermined.
Anesthesiology, 2005
Postoperative analgesia is generally limited to 12-16 h or less after single-injection regional nerve blocks. Postoperative analgesia may be provided with a local anesthetic infusion via a perineural catheter after initial regional block resolution. This technique may now be used in the outpatient setting with the relatively recent introduction of reliable, portable infusion pumps. In this review article, we summarize the available published data related to this new analgesic technique and highlight important issues related specifically to perineural infusion provided in patients' own homes. Topics include infusion benefits and risks, indications and patient selection criteria, catheter, infusion pump, dosing regimen, and infusate selection, and issues related specifically to home-care.
BMC anesthesiology, 2015
The use of femoral nerve block (FNB) combined with sciatic nerve block (SNB) after total knee arthroplasty (TKA) has recently become controversial. Local infiltration analgesia (LIA) has been reported to be effective for postoperative TKA pain control. We aimed to assess whether LIA with continuous FNB is as effective as SNB combined with continuous FNB. This was a prospective, randomized, single-center, observer-blinded, parallel group comparison trial of 34 American Society of Anesthesiologists (ASA) physical status 1-3 patients who underwent TKA and fulfilled the inclusion and exclusion criteria. Patients were randomized into two groups: a periarticular LIA and FNB group (group L, n = 17), and an SNB and FNB group (group S, n = 17). In both groups, participants received FNB with 20 mL of 0.375% ropivacaine, and 5 mL h(-1) of 0.2% ropivacaine after surgery. In group L, participants received 100-ml injections of 0.2% ropivacaine and 0.5 mg epinephrine to the surgical region. In gro...
Ain Shams Journal of Anesthesiology, 2022
Background: Inadequate pain management after total knee replacement (TKR) prolongs recovery time and increases the risk of postoperative complications. Peripheral nerve fibres blockade has been used as a mode of analgesia after TKR. Femoral nerve block (FNB) is often used to provide postoperative analgesia after TKR. However, FNB causes quadriceps muscle weakness leading to delayed ambulation, patient discomfort and prolonged hospital stay. Nowadays, saphenous nerve block is a relatively new alternative being superior to FNB for providing pure blockage of sensory nerve fibres with preserving quadriceps muscle strength. Results: Results of this study showed that leg raising test percentages were significantly higher in group S compared to group F (86.7% versus 43.3% respectively), whereas, time up and go (TUG) test values were significantly lower in group S compared to group F (Mean ±SD values were 22.47 ± 4.93 versus 44.6 ± 4.18 respectively with a p-value < 0.0001). Numerical rating score (NRS) for pain scoring was measured at 30 min after admission to PACU, 3, 6, 12 and 24hrs postoperatively showed no significant differences in both groups F & S (1;(0-2), 1;(1-2), 2;(1-2), 2;(1-2), 2;(2-2) versus 1;(0-2), 1;(1-2), 2;(1-3), 2;(1-2), 2;(2-3) respectively with a p-value 0.42, 0.1, 0.1, 0.49, 0.67). Also, both groups showed no significant difference in cumulative 1 st 24hrs Nalbuphine consumption (Mean ±SD were 15.33 ± 7.3 for F group versus 14.33 ± 6.26 for S group with a p-value 0.57). Conclusions: Despite the excellent analgesic effect of FNB, saphenous nerve block could be a favorable choice as a mode of analgesia after TKR, as it preserves quadriceps motor strength and promotes early mobilization compared to FNB.