Adding a low-concentration sciatic nerve block to total knee arthroplasty in patients susceptible to the adverse effects of non-steroidal anti-inflammatory drugs (NSAIDs): a randomized controlled trial

Abstract

Background This study compared the effects of adductor canal blocks with those of a low concentration of popliteal-sciatic nerve block (SNB) and dexamethasone as an adjunctive technique for total knee arthroplasties (TKA) in patients susceptible to the adverse effects of NSAIDs. Methods A prospective, double-blinded, randomized controlled trial was performed in 50 patients susceptible to the adverse effects of NSAIDs undergoing unilateral TKAs. All patients received spinal anesthesia, adductor canal blocks, and periarticular infiltration. The 25 patients in the intervention group received SNB (0.125% bupivacaine [20 ml] and dexamethasone [5 mg]). Results The SNB group significantly had lower median resting pain scores at 6, 12, and 18 h: the control group, 1 (0–4.5), 3 (0–5), and 3 (2–5); the intervention group, 0 (0–0), 0 (0–3), and 1 (0–3); p-values, 0.012, 0.021, and 0.010, respectively. Movement-evoked pain scores at 6, 12, and 18 h were also lower: control group, 3 (0–5.5), 5 (2.5–6.5), and 7 (4–9); intervention group, 0 (0–1.5), 2 (0–4), and 3 (2–5); p-values, 0.019, 0.005, and 0.001, respectively. There were no differences in motor function. Moreover, the mean morphine consumption 24 h was also reduced in the SNB group: control group, 3.80 ± 2.48 mg; intervention group, 1.96 ± 2 mg; p-value, 0.005. Conclusion For patients susceptible to the adverse effects of NSAIDs, a low concentration of SNB and dexamethasone is an effective adjunctive technique for early postoperative pain control (especially on movement) following TKAs, without an increase in motor weakness. Trial registration ClinicalTrials.gov, NCT03486548, Registered 3 April 2018.

Clinical Application of Perioperative Anaesthesia Management Based on Enhanced Recovery after Surgery Concept to Elderly Patients Undergoing Total Knee Replacement

“…As the primary treatment for end-stage knee OA, TKR can effectively relieve knee pain and improve patients' knee function, hence its clinical application is wider [ 3 ]. However, patients undergoing knee replacement are prone to postoperative complications such as pain, deep vein thrombosis, and pulmonary infection, in particular, the elderly patients with comorbid basic diseases such as diabetes mellitus and hypertension tend to have abnormal blood glucose index and blood pressure index, leading to higher complication rates [ 4 , 5 ] and resulting in significantly increased length of hospital stay and hospital costs. To improve the surgical outcomes of elderly patients, current clinical efforts have been devoted to promoting the concept of enhanced recovery after surgery (ERAS), which refers to a multidisciplinary approach in the perioperative period to scientifically and effectively reduce the perioperative stress response and complication rate, thus reducing the incidence of infectious complications and chronic complications and achieving the goal of rapid rehabilitation [ 6 , 7 ].…”

A randomized clinical trial of addition of IPACK block or selective tibial nerve block to adductor canal block for postoperative pain management after total knee arthroplasty

“…This nerve is not routinely blocked because clinicians are afraid of causing a motor block, which could compromise the postoperative evaluation. 9 Tibial nerve block (TNB) is recommended as it includes just the tibial nerve component of the sciatic nerve and produces less block of the common peroneal nerve (CPN). 10 However, the proximal distribution of local anesthetic (LA) to the sciatic nerve might result in unwanted motor blockade.…”