Does Combination Therapy of Popliteal Sciatic Nerve Block and Adductor Canal Block Effectively Control Early Postoperative Pain after Total Knee Arthroplasty?
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Purpose: We compared adductor canal block (ACB) alone and a combination of ACB and sciatic nerve block (SNB) to control early postoperative pain after total knee arthroplasty. Materials and Methods: One hundred patients received continuous ACB alone (group A), and another 100 patients received continuous ACB and single popliteal SNB (group B). Pain was evaluated at rest and 45° knee flexion using the numeric rating scale (NRS). The number of times the patient pressed the intravenous patient-controlled analgesia (PCA) button, total PCA volume infused, and the total dosage of additional analgesics were evaluated. We also investigated complications associated with each pain control technique. Results: The NRS score on postoperative day 1 was significantly lower in group B than in group A. The number of times patients pressed the PCA button on postoperative day 1 and the total infused volume were significantly lower in group B than in group A. Thirty-five (35%) patients in group B developed foot drop immediately after surgery; but they all fully recovered on postoperative day 1. Conclusions: SNB can be effective for management of early postoperative pain that persists even after ACB. Further research is needed to determine the proper dosage and technique for reducing the incidence of foot drop.
Abstract
Purpose: We compared adductor canal block (ACB) alone and a combination of ACB and sciatic nerve block (SNB) to control early postoperative pain after total knee arthroplasty. Materials and Methods: One hundred patients received continuous ACB alone (group A), and another 100 patients received continuous ACB and single popliteal SNB (group B). Pain was evaluated at rest and 45° knee flexion using the numeric rating scale (NRS). The number of times the patient pressed the intravenous patient-controlled analgesia (PCA) button, total PCA volume infused, and the total dosage of additional analgesics were evaluated. We also investigated complications associated with each pain control technique. Results: The NRS score on postoperative day 1 was significantly lower in group B than in group A. The number of times patients pressed the PCA button on postoperative day 1 and the total infused volume were significantly lower in group B than in group A. Thirty-five (35%) patients in group B developed foot drop immediately after surgery; but they all fully recovered on postoperative day 1. Conclusions: SNB can be effective for management of early postoperative pain that persists even after ACB. Further research is needed to determine the proper dosage and technique for reducing the incidence of foot drop.
참고문헌 (22)
- Singelyn FJ, "Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous femoral nerve sheath block on rehabilitation after unilateral total-hip arthroplasty", Reg Anesth Pain Med, 30, pp.452~457 (2005)
- Paul JE, "Femoral nerve block improves analgesia outcomes after total knee arthroplasty : a meta-analysis of randomized controlled trials", Anesthesiology, 113, pp.1144~1162 (2010)
- Ilfeld BM, "Ambulatory continuous femoral nerve blocks decrease time to discharge readiness after tricompartment total knee arthroplasty : a randomized, triple-masked, placebo-controlled study", Anesthesiology, 108, pp.703~713 (2008)
- Safa B, "Comparing the effects of single shot sciatic nerve block versus posterior capsule local anesthetic infiltration on analgesia and functional outcome after total knee arthroplasty : a prospective, randomized, double-blinded, controlled trial", J Arthroplasty, 29, pp.1149~1153 (2014)
- Abdallah FW, "Is sciatic nerve block advantageous when combined with femoral nerve block for postoperative analgesia following total knee arthroplasty? A systematic review", Reg Anesth Pain Med, 36, pp.493~498 (2011)
- Abdallah FW, "Is sciatic nerve block advantageous when combined with femoral nerve block for postoperative analgesia following total knee arthroplasty? a meta-analysis", Can J Anaesth, 63, pp.552~568 (2016)
- Li J, "Combined femoral and sciatic nerve block versus femoral and local infiltration anesthesia for pain control after total knee arthroplasty : a meta-analysis of randomized controlled trials", J Orthop Surg Res, 11, pp.158~ (2016)
- Wang C, "Comparison of periarticular multimodal drug injection and femoral nerve block for postoperative pain management in total knee arthroplasty : a systematic review and meta-analysis", J Arthroplasty, 30, pp.1281~1286 (2015)
- Gao F, "Adductor canal block versus femoral nerve block for analgesia after total knee arthroplasty : a systematic review and meta-analysis", Clin J Pain, 33, pp.356~368 (2017)
- 고인준, "Femoral Nerve Block versus Adductor Canal Block for Analgesia after Total Knee Arthroplasty", Knee Surgery and Related Research, 29(2), pp.87~95 (2017), 대한슬관절학회
- Sinha A, "Ultrasound imaging for popliteal sciatic nerve block", Reg Anesth Pain Med, 29, pp.130~134 (2004)
- Grape S, "The analgesic efficacy of sciatic nerve block in addition to femoral nerve block in patients undergoing total knee arthroplasty : a systematic review and meta-analysis", Anaesthesia, 71, pp.1198~1209 (2016)
- Mullaji A, "Efficacy of periarticular injection of bupivacaine, fentanyl, and methylprednisolone in total knee arthroplasty : a prospective, randomized trial", J Arthroplasty, 25, pp.851~857 (2010)
- Sinha SK, "Femoral nerve block with selective tibial nerve block provides effective analgesia without foot drop after total knee arthroplasty : a prospective, randomized, observer-blinded study", Anesth Analg, 115, pp.202~206 (2012)
- Weber A, "Sciatic nerve block and the improvement of femoral nerve block analgesia after total knee replacement", Eur J Anaesthesiol, 19, pp.834~836 (2002)
- Chelly JE, "Continuous femoral blocks improve recovery and outcome of patients undergoing total knee arthroplasty", J Arthroplasty, 16, pp.436~445 (2001)
- Eledjam JJ, "Postoperative analgesia by femoral nerve block with ropivacaine 0.2% after major knee surgery: continuous versus patient-controlled techniques", Reg Anesth Pain Med, 27, pp.604~611 (2002)
- Mahadevan D, "Combined femoral and sciatic nerve block vs combined femoral and periarticular infiltration in total knee arthroplasty : a randomized controlled trial", J Arthroplasty, 27, pp.1806~1811 (2012)
- Singelyn FJ, "Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous three-in-one block on postoperative pain and knee rehabilitation after unilateral total knee arthroplasty", Anesth Analg, 87, pp.88~92 (1998)
- Danelli G, "Ultrasound vs nerve stimulation multiple injection technique for posterior popliteal sciatic nerve block", Anaesthesia, 64, pp.638~642 (2009)
- Nercessian OA, "Peroneal nerve palsy after total knee arthroplasty", J Arthroplasty, 20, pp.1068~1073 (2005)
- Jacob AK, "Perioperative nerve injury after total knee arthroplasty : regional anesthesia risk during a 20-year cohort study", Anesthesiology, 114, pp.311~317 (2011)