A Comparison of Epidural Anesthesia and Lumbar Plexus-Sciatic Nerve Blocks for Knee Surgery

Abstract

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.

Study on evaluating the Adequacy of Psoas Compartment Block and Sacral Plexus Block for Lower Limb Surgeries

“…Overall, patients' and surgeons' satisfaction in our study was 96.8% and 95.7% respectively. When compared with the study conducted by Horasanli et al 14 (patients' and surgeons' satisfaction was 75.7% and 81% respectively), patients' and surgeons' satisfaction was comparatively high. The high satisfaction rate was probably because of dexmedetomidine-induced sedation and enhanced motor and sensory blockade.…”

“…Patients' and surgeons' satisfaction with the nerve block technique was evaluated using a two-point scale 14 :…”

Peripheral regional anaesthesia and outcome: lessons learned from the last 10 years

“…116 117 120 121 The onset of analgesia was delayed compared with the neuraxial technique, but the time to first analgesic needed was longer. 121 Eight articles have been published with respect to arthroscopic knee surgery employing sciatic or combined sciatic blocks. Compared with spinal anaesthesia, peripheral nerve blocks show similar 122 or even better pain relief.…”

Effect of continuous psoas compartment block and intravenous patient controlled analgesia on postoperative pain control after total knee arthroplasty

“…These effects hinder early walking and rehabilitation, which are important to a quick recovery and early hospital discharge [2,7,8]. Therefore, postoperative pain management is considered an important prognosis factor.…”