Background And Objectives: The benefit of adding a sciatic nerve block to the femoral block to improve analgesia after total knee replacement is controversial. The aim of this study is to address this controversy in a prospective, comparative, and randomized study.
Methods: Patients were allocated randomly to receive a continuous femoral nerve block or continuous blocks of both the femoral and sciatic nerves. Stimulating catheters were used in all cases. A loading dose of 15 mL ropivacaine 0.75% was injected into each catheter, followed by administration of ropivacaine 0.2% (2-5 mL/h infusion via the femoral catheter; bolus 10 mL repeated every 12 hours in the sciatic catheter). The primary outcome was visual analog scale (VAS) scores (0 = no pain, 100 mm = worst pain) in postanesthesia care unit and in the 48-hour period after surgery. The secondary outcomes were amplitude of knee flexion, morphine consumption, and occurrence of postoperative nausea and vomiting (PONV).
Results: The VAS scores at rest were significantly higher when there was only continuous femoral nerve block than when there was both continuous femoral and sciatic nerve blocks. This difference progressively decreased and disappeared at 36 hours after surgery. The combined femoral and sciatic blocks decreased the morphine consumption by 81% and significantly decreased the occurrence of PONV.
Conclusion: During the 36 hours immediately after total knee replacement, the combination of continuous femoral and sciatic nerve blocks improves analgesia while decreasing morphine consumption and PONV.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.rapm.2004.11.009 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Intra-individual variability in ancient plasmodium DNA recovery highlights need for enhanced sampling.
Sci Rep
January 2025
Department of Evolutionary Anthropology, University of Vienna, Vienna, Austria.
Malaria has been a leading cause of death in human populations for centuries and remains a major public health challenge in African countries, especially affecting children. Among the five Plasmodium species infecting humans, Plasmodium falciparum is the most lethal. Ancient DNA research has provided key insights into the origins, evolution, and virulence of pathogens that affect humans.
View Article and Find Full Text PDFThe Effects of Inaccurate Femoral Tunnel Placement During Medial Patellofemoral Ligament Reconstruction on Midterm Clinical Outcomes in Treatment of Recurrent Patellar Dislocation.
Am J Sports Med
January 2025
Department of Sports Medicine, Peking University Third Hospital; Institute of Sports Medicine of Peking University; Beijing Key Laboratory of Sports Injuries, Beijing, China.
Background: There is a lack of evidence and continuous debate on whether femoral tunnel displacement substantially influences the clinical efficacy of medial patellofemoral ligament reconstruction (MPFL-R) in addressing recurrent patellar dislocation.
Purpose: To investigate possible associations between inaccurate femoral tunnel placement during MPFL-R and clinical outcomes, with a specific focus on proximal tunnel malpositioning.
Study Design: Cohort study; Level of evidence, 3.
Associations Between Skeletal Alignment and Biomechanical Symmetry Before and After Transfemoral Bone-anchored Limb Implantation.
Clin Orthop Relat Res
December 2024
Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA.
Article Synopsis
- Patients with transfemoral amputation often face issues related to socket fit and overuse injuries due to uneven joint stress, which can be improved by using bone-anchored prosthetics that connect directly to the bone.
- This study investigates the relationship between the alignment of the femur and pelvis and how it impacts hip loading asymmetry during walking, both before and one year after receiving a bone-anchored limb implant.
- The analysis included 19 participants from a larger group who underwent the surgery, comparing their skeletal alignment and hip motion data collected at two different time points to determine the effects of the implantation on their mobility and joint loading.
Specific approach to total hip arthroplasty in patients with childhood hip disorders sequelae.
World J Orthop
December 2024
Department for Science, Dubai College, Dubai 00000, Dubayy, United Arab Emirates.
Hip arthroplasty in patients with a history of paediatric hip disorders presents a significant challenge for orthopaedic surgeons. These patients are typically younger and have greater functional demands. Therefore, achieving optimal biomechanical conditions is crucial, involving placement of the acetabulum at the ideal centre of rotation and securing a stable femoral component with good offset to preserve abductor muscle function and restore leg length.
View Article and Find Full Text PDFHaemodynamic measurements during hip hemiarthroplasty surgery for hip fracture.
Bone Joint J
January 2025
Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kadoorie Centre, University of Oxford, Oxford, UK.
Aims: There is compelling evidence for the use of cemented hip hemiarthroplasty for displaced intracapsular hip fractures; however, the risks of cement are well reported and in rare cases may be associated with haemodynamic collapse. It is therefore important to improve our understanding of haemodynamic instability, intraoperative monitoring, and strategies to reduce the risk to patients.
Methods: We measured arterial blood pressure using the LiDCO Continuous Non-invasive Arterial Pressure (CNAP) finger cuff during surgery in patients enrolled in the WHiTE 5 trial randomized to cemented or modern uncemented hip hemiarthroplasty at a single recruiting site.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!