A comparison of analgesic techniques for total knee arthroplasty: A network meta-analysis

Qin, Lu; You, Di; Zhao, Guoqing; Li, Longyun; Zhao, Shuhong

doi:10.1016/j.jclinane.2021.110257

Cited by 24 publications

(26 citation statements)

References 110 publications

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“…Therefore, posterior lumbar plexus block anesthesia blocks all lumbar nerves and some sacral nerves. In addition, because the lumbar plexus block is located close to the spinal nerve, it can achieve the same effect as the spinal canal block [ 18 , 19 ]. A posterior lumbar plexus block is only performed on one limb, which can reduce the hemodynamic fluctuations stemming from a sympathetic nerve block after intraspinal anesthesia and bilateral lower limb block [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Posterior Lumbar Plexus Block Anesthesia for Elderly Patients with Lower Limb Fracture

Xu¹,

Li²,

Wu³

et al. 2022

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The incidence rate of lower limb fractures is high and has increased over the recent years, which affects the physical and mental health and the daily activities of patients. Lower limb fractures are often treated surgically. Therefore, an effective anesthesia regimen is crucial for a smooth and stable operation. To investigate the efficacy of posterior lumbar plexus block anesthesia during surgery for elderly patients with lower extremity fractures. In total, patients were divided into study and control groups. Anesthesia was administered by posterior lumbar plexus nerve block in the study group and epidural anesthesia in the control group. Hemodynamic parameters, anesthesia condition, pain level (VAS), and adverse effects were measured in both groups before anesthesia (T0), at anesthesia induction (T1), 30 min into the operation (T2), and at the end of the operation (T3). At T0, there were no significant differences in MAP and HR between the study and control groups. However, MAP and HR in the study group were significantly lower than those in the control group at T1, T2, and T3. The BIS value of the study group at each time point after anesthesia was significantly lower than that of the control group. The onset and induction time of anesthesia in the study group were also significantly shorter than those in the control group. Preoperative VAS scores did not differ between the study and control groups. However, the VAS scores of the study group at each time point were significantly lower than those of the control group. There was no significant difference in the incidence of adverse reactions between the two groups. Our results suggest that anesthesia with posterior lumbar plexus block surgery for lower extremity fractures in elderly patients can maintain hemodynamic stability and reduce block onset time, anesthesia induction time, and pain.

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Section: Discussionmentioning

confidence: 99%

Posterior Lumbar Plexus Block Anesthesia for Elderly Patients with Lower Limb Fracture

Xu¹,

Li²,

Wu³

et al. 2022

Disease Markers

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“…The most important finding of the present study is that the opioids needed in the first 48 h after surgery in the USRA group were significantly lower, a finding that indicates better early postoperative pain control after primary TKA. However, it has to be highlighted that the observed opioid consumption in the LIA group of 42 mg OME (14 mg morphine intravenous in 48 h) is lower than in any study described in a recent review [ 20 ]. Furthermore, it could be shown that the maximum NRS scores were lower in the USRA group from day 0 to day 2 after TKA, reaching a significant difference on day 1 (Table 3 ).…”

Section: Discussionmentioning

confidence: 93%

Combined femoral and popliteal nerve block is superior to local periarticular infiltration anaesthesia for postoperative pain control after total knee arthroplasty

Schittek

Reinbacher

Rief

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Introduction After primary total knee arthroplasty (TKA), local periarticular infiltration anaesthesia (LIA) is a fast and safe method for postoperative pain control. Moreover, ultrasound-guided regional anaesthesia (USRA) with femoral and popliteal block is a standard procedure in perioperative care. Two analgesic regimens for TKA—LIA versus URSA with dexmedetomidine—were compared as an additive to ropivacaine. We hypothesised that the use of URSA provides a superior opioid sparing effect for TKA compared with LIA. Methods Fifty patients (planned 188 participants; safety analysis was performed after examining the first 50 participants) were randomised. These patients received LIA into the knee capsule during surgery with 60 ml of ropivacaine 0.5% and 1 ml of dexmedetomidine (100 µg ml−1) or two single-shot URSA blocks (femoral and popliteal block) before surgery with 15 ml of ropivacaine 0.5% and 0.5 ml of dexmedetomidine for each block. Postoperative opioid consumption in the first 48 h, pain assessment and complications were analysed. Results In the safety analysis, there was a significantly higher need for opioids in the LIA group, with a median oral morphine equivalent of 42.0 [interquartile range (IQR) 23.5–57.0] mg versus 27.0 [IQR 0.0–33.5] mg (P = 0.022). Due to this finding, the study was terminated for ethical considerations according to the protocol. Conclusion This is the first study presenting data on LIA application in combination with dexmedetomidine. A superior opioid-sparing effect of URSA was observed when compared with LIA in TKA when dexmedetomidine is added to local anaesthetics. Also, a longer lasting opioid-sparing effect in the LIA group was observed when compared with the recently published literature; this difference could be attributed to the addition of dexmedetomidine. Therefore, multimodal analgesia regimens could be further improved when LIA or USRA techniques are combined with dexmedetomidine.

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“…Two recent meta-analyses demonstrated superior analgesia with FN block compared with more distal, motor-sparing approaches in the distal femoral triangle or adductor canal. 34-36 This provides some evidence that proximal FN branches, including the femoral cutaneous nerves and nerves to the muscles via their genicular branches, play a role in pain following TKA. More distal block locations may not include these nerves.…”

Section: Pro—the Location For Injection Mattersmentioning

confidence: 98%

Pro and Con: How Important Is the Exact Location of Adductor Canal and Femoral Triangle Blocks?

Woodworth

Arner

Nelsen

et al. 2023

Anesthesia &Amp; Analgesia

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In this Pro-Con commentary article, we debate the importance of anterior thigh block locations for analgesia following total knee arthroplasty. The debate is based on the current literature, our understanding of the relevant anatomy, and a clinical perspective. We review the anatomy of the different fascial compartments, the course of different nerves with respect to the fascia, and the anatomy of the nerve supply to the knee joint. The Pro side of the debate supports the view that more distal block locations in the anterior thigh increase the risk of excluding the medial and intermediate cutaneous nerves of the thigh and the nerve to the vastus medialis, while increasing the risk of spread to the popliteal fossa, making distal femoral triangle block the preferred location. The Con side of the debate adopts the view that while the exact location of local anesthetic injection appears anatomically important, it has not been proven to be clinically relevant.

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A comparison of analgesic techniques for total knee arthroplasty: A network meta-analysis

Cited by 24 publications

References 110 publications

Posterior Lumbar Plexus Block Anesthesia for Elderly Patients with Lower Limb Fracture

Posterior Lumbar Plexus Block Anesthesia for Elderly Patients with Lower Limb Fracture

Combined femoral and popliteal nerve block is superior to local periarticular infiltration anaesthesia for postoperative pain control after total knee arthroplasty

Pro and Con: How Important Is the Exact Location of Adductor Canal and Femoral Triangle Blocks?

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