Efficacy of Sciatic Nerve Block for Pain Management in below Knee Orthopaedic Surgery (original) (raw)
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.
Postoperative analgesia in a patient with knee surgery -use of a single puncture SOFT block
Sri Lankan Journal of Anaesthesiology: 27(1):83-85(2019), 2019
Postoperative analgesia after knee surgeries requires multiple nerve blocks. A twenty nine year old ASA I female was posted for arthroscopic anterior cruciate ligament repair. The procedure was done under spinal anaesthesia with 3ml of 0.5% hyperbaric bupivacaine and 30µg of preservative free clonidine. At the end of the surgery which lasted for 140 minutes, a single puncture access to all the nerves (sciatic, femoral and obturator-SOFT block) was done just at the inguinal region using ultrasound guidance. The blockade of all the nerves was confirmed after the complete recovery of spinal anaesthesia in the other leg. The analgesia lasted for 15 hours after the spinal recovery. Complete recovery from block was ensured as the block was administered with spinal anaesthesia to rule out any form of nerve injury. Introduction With regard to the neuronal anatomy and clinical experience, the blockade of sciatic, obturator and femoral nerves seems to be an effective block and may be a promising method to provide adequate analgesia for surgical procedures of knee. 1 Conventionally this would require a change in positioning of the patient, probe and needle, which could cause discomfort for the patient and be time consuming. 2 We present a case report where a relatively new block called SOFT block (Sciatic, obturator and femoral nerve block technique) was used for analgesia after surgical procedure of the knee to manage postoperative pain with a single puncture.
Türk anestezi ve reanimasyon dergisi, 2018
Compared to ropivacaine, levobupivacaine is more lipophilic and a more potent vasoconstrictor. The study was conducted to compare the effect of 0.5% ropivacaine and 0.5% levobupivacaine in sciatic nerve block using conventional Labat approach in foot and ankle surgery. Methods: A prospective double-blind, randomised study was carried out in 100 patients of either sex, aged between 20 to 60 years, and American Society of Anesthesiologist (ASA) grades I and II. Patients were randomly allocated into groups R and L of 50 each with 0.5% ropivacaine and 0.5% levobupivacaine, respectively, for sciatic nerve block using the Labat approach. We assessed the onset and duration of sensory and motor block, duration of analgesia, consumption of analgesic, and any untoward effect over 24 hours. Results: Both the groups were comparable with regard to demographic variables and onset of sensory and motor block (p>0.05). Group L compared to group R had significantly longer median (95% confidence interval) duration of sensory block (647.50 min [624.99-674.41] vs. 535 min [524.77-559.83], respectively; p<0.0001) as well as motor block (1065.0 min [1054.5-1068.90] and 945 min [947.13-1013.30], respectively; p<0.0001). Postoperative analgesia also lasted significantly longer in group L compared to group R (1320 min [1273.4-1321.8] vs. 840 min [759.23-812.77]; p<0.0001]). Patients in group L had significantly better visual analogue scale (VAS) score and lesser consumption of analgesics (p<0.0001). None of the groups developed any adverse effect over the observation period. Conclusion: Levobupivacaine provides prolonged postoperative analgesia in sciatic nerve block with reduction in postoperative analgesic consumption.
Anesthesia & Analgesia, 2008
BACKGROUND-It remains unknown whether local anesthetic concentration, or simply total drug dose, is the primary determinant of continuous peripheral nerve block effects. We therefore tested the null hypothesis that providing different concentrations and rates of ropivacaine, but at equal total doses, produces comparable effects when used in a continuous sciatic nerve block in the popliteal fossa. METHODS-Preoperatively, a perineural catheter was inserted adjacent to the sciatic nerve using a posterior popliteal approach in patients undergoing moderately painful orthopedic surgery at or distal to the ankle. Postoperatively, patients were randomly assigned to receive a perineural ropivacaine infusion of either 0.2% (basal 8 mL/h, bolus 4 mL) or 0.4% (basal 4 mL/h, bolus 2 mL) through the second postoperative day. Therefore, both groups received 16 mg of ropivacaine each hour with a possible addition of 8 mg every 30 min via a patient-controlled bolus dose. The primary end point was the incidence of an insensate limb, considered undesirable, during the 24-h period beginning the morning after surgery. Secondary end points included analgesia and patient satisfaction. RESULTS-Patients given 0.2% ropivacaine (n = 25) experienced an insensate limb with a mean (SD) of 1.8 (1.8) times, compared with 0.6 (1.1) times for subjects receiving 0.4% ropivacaine
International Journal of Environmental Research and Public Health
Regional anesthesia has been considered a great tool for maximizing post-operative pain control while minimizing opioid consumption. Post-operative rebound pain, characterized by hyperalgesia after the peripheral nerve block, can however diminish or negate the overall benefit of this modality due to a counter-productive increase in opioid consumption once the block wears off. We reviewed published literature describing pathophysiology and occurrence of rebound pain after peripheral nerve blocks in patients undergoing orthopedic procedures. A search of relevant keywords was performed using PubMed, EMBASE, and Web of Science. Twenty-eight articles (n = 28) were included in our review. Perioperative considerations for peripheral nerve blocks and other alternatives used for postoperative pain management in patients undergoing orthopedic surgeries were discussed. Multimodal strategies including preemptive analgesia before the block wears off, intra-articular or intravenous anti-inflammat...
Anesthesia & Analgesia, 2005
We prospectively tested the hypothesis that the use of a stimulating catheter improves the efficacy of continuous posterior popliteal sciatic nerve block in 100 randomized patients scheduled for elective orthopedic foot surgery. After eliciting a sciatic mediated muscular twitch at Յ0.5 mA nerve stimulation output, the perineural catheter was advanced 2-4 cm beyond the tip of the introducer either blindly (Group C; n ϭ 50) or stimulating via the catheter (Group S; n ϭ 50). A bolus dose of 25 mL of 1.5% mepivacaine was followed by a postoperative patientcontrolled infusion of 0.2% ropivacaine (basal infusion: 3 mL/h; incremental dose: 5 mL; lockout time: 30 min). Propacetamol 2 g IV was administered every 8 h, and opioid rescue analgesia was available if required. Catheter placement required 7 Ϯ 2 min in Group S and 5 Ϯ 2 min in Group C (P ϭ 0.056). A significantly shorter onset time of both sensory and motor blocks was noted in Group S. No difference in quality of pain relief at rest and during motion was reported between the groups. Median (range) local anesthetic consumption during the first 48 h after surgery was 239 mL (175-519 mL) and 322 mL (184 -508 mL) in Groups S and C, respectively (P ϭ 0.002). Rescue opioid analgesia was required by 12 (25%) and 28 (58%) patients in Groups S and C, respectively (P ϭ 0.002). We conclude that the use of a stimulating catheter results in shorter onset time of posterior popliteal sciatic nerve block, similar pain relief with reduced postoperative consumption of local anesthetic solution, and less rescue opioid consumption.
Continuous Popliteal Sciatic Nerve Block for Postoperative Pain Control at Home
Anesthesiology, 2002
Background This randomized, double-blinded, placebo-controlled study investigated the efficacy of patient-controlled regional analgesia using a sciatic perineural catheter in the popliteal fossa and a portable infusion pump for outpatients having moderately painful, lower extremity orthopedic surgery. Methods Preoperatively, patients (n = 30) received a sciatic nerve block and perineural catheter in the popliteal fossa. Postoperatively, patients were discharged with both oral opioids and a portable infusion pump delivering study solution (0.2% ropivacaine or 0.9% saline) via the catheter for 3 days. Investigators and patients were blinded to random group assignment. Daily end-points included pain scores, opioid use and side effects, sleep quality, and symptoms of catheter- or local anesthetic-related complications. Results Ropivacaine (n = 15) infusion significantly reduced pain compared with saline (n = 15) infusion ( < 0.001). For example, the average pain at rest (scale: 0-10)...
A Comparison of Epidural Anesthesia and Lumbar Plexus-Sciatic Nerve Blocks for Knee Surgery
Clinics, 2010
OBJECTIVES: The efficacy of combined lumbar plexus-sciatic nerve blocks was compared to epidural anesthesia in patients undergoing total knee surgery. PATIENTS AND METHODS: The study included 80 American Society of Anesthesiologists (ASA) Physical Status I-III patients (age range 18 to 65) undergoing knee surgery. The patients were randomly divided into one of two groups. Epidural anesthesia was performed in the epidural anesthesia (EA) group (n=40), and the lumbar plexus and sciatic nerves were blockedin the lumbar plexus-sciatic nerve blocks (LPSB) group (n=40). For each patient, onset of sensory and motor block, degree of motor block, sign of sensory block in the contralateral lower limb for the lumbar plexus-sciatic nerve blocks group, success in providing adequate anesthesia, hemodynamic changes, time of first analgesic request, and patient and surgeon satisfaction with the anesthetic technique were recorded. RESULTS: One patient in the epidural anesthesia group and three patients in the lumbar plexus-sciatic nerve blocks group required general anesthesia due to failed block. There were no significant differences between the two groups regarding the success of providing adequate anesthesia. Eight patients in the lumbar plexus-sciatic nerve blocks group developed contralateral spread. The onset of sensory-motor block and the time of the first analgesic request were significantly later in the lumbar plexus-sciatic nerve blocks group than in the epidural anesthesia group. Although there were no significant differences regarding patient satisfaction with the anesthetic technique between the two groups, surgeon satisfaction was significantly higher in the lumbar plexus-sciatic nerve blocks group than in the epidural anesthesia group. CONCLUSION: The lumbar plexus-sciatic nerve blocks provide effective unilateral anesthesia and may offer a beneficial alternative to epidural anesthesia in patients undergoing total knee surgery.
IP Innovative Publication Pvt. Ltd., 2018
Aim and Objectives: Aim of the present study was to compare the efficacy of the block, hemodynamic effects, postoperative analgesia and side effects of combined psoas compartment sciatic nerve block with continuous spinal anaesthesia in adult patients undergoing lower extremity surgeries. Materials and Methods: Sixty patients of either sex, ASA grade I, II and III, age between 18-70 years, were randomly allocated into two groups. In group A, psoas compartment block was performed by posterior approach using 30cc of 0.25% bupivacaine and sciatic nerve block by classical posterior approach using the 20cc of 0.25% bupivacaine. In group B, continuous spinal anaesthesia was performed in the L3-L4 interspaced with the patient in lateral decubitus position using 3cc (15 mg) of 0.5% heavy bupivacaine. We studied various parameters of block, hemodynamic effects, duration of postoperative analgesia and any complications. Results: Group B had earlier onset of sensory and motor block as compare to group A. The mean duration of sensory and motor block was significantly prolonged in group A than in group B. The efficacy of sensory blockade was comparable in both the groups while in group A 90% patients and in group B 97% of patients had complete motor blockade. The incidence of hypotension was more with group B as compared to group A. The duration of post-operative analgesia was longer in group A than in group B. No major complications were observed in both the groups. Conclusions: It was concluded that combined psoas compartment block and sciatic nerve block is a beneficial alternative to existing anaesthesia techniques for lower extremities surgeries. Keywords: Bupivacaine, Combined psoas compartment-sciatic nerve block, Continuous spinal anaesthesia, Lower extremity surgeries, Post-operative analgesia, Sensory and motor blockade.