Objective: The objective of this study was to compare postoperative early (48 hours) visual analogue scale (VAS) scores following combined spinal epidural anesthesia (CSEA) and ultrasound-guided femoral nerve block (FNB) in patients undergoing total knee arthroplasty (TKA).
Material and Methods:This retrospective study included 302 patients who underwent CSEA (Group CSEA) and FNB (Group FNB) for elective unilateral total knee arthroplasty between May 2016 and May 2017. Postoperative Visual analogue scale (VAS) scores at rest and during activity (30th min, 2, 6, 12, 24 and 48th hours), the total amount of morphine consumed (48th hour) by the patient controlled analgesia (PCA) device, and the complications were evaluated.
Results:The demographic characteristics of the patients were similar (p>0.05). There was no statistically significant difference between the two groups in terms of resting and active VAS scores according to timepoints (p>0.05). However, there was a significant difference in complications (hypotension, nausea and vomiting, neurological damage, respiratory depression, pruritus) between the two groups (p<0.05).
Conclusion:Pain levels after total knee arthroplasty showed that FNB had a similar effect with CSEA in providing pain relief, but FNB was superior to CSEA in terms of postoperative complications. themselves; Group CSEA (n:95) and Group FNB (n:152) [(patients who were routinely practiced FNB in our clinic were selected)]. The anesthesia methods applied to the patients were routinely based on the preference of the patient, the laboratory and clinical data of the patient, and the choice of the anesthesia practitioner. Both of these two methods were used with the i.v. morphine patient controlled analgesia device (PCA) that is in routine use at our clinic.Sociodemographic data, operation times, tourniquet times, side of surgery and pain scores at time points (30th min, 2, 6, 12 24 and 48th hours) were evaluated using postoperative visual pain scale (VAS) scores at rest and during activity by the postoperative patient controlled analgesia (PCA) device. Total morphine consumption was recorded at the 48th hour.In Group CSEA, the epidural space was entered with an 18 G Tuohy needle from the L2-3 or L3-4 interspinous area in the sitting or lateral decubitus position. Then, a needle was inserted through the needle into the spinal cord with a 26 G Quincke needle, and 3 ml of 0.5% spinal bupivacaine (15 mg) was applied. After the spinal needle was removed, 20 G epidural catheter was advanced in the epidural space for 3-4 cm.In Group FNB, femoral nerve block was performed after spinal anesthesia with ultrasonic guidance using a linear probe (10-18 MHz) using the "in-plane" technique to observe the femoral nerve and motor activity (0.5 mA, 0.1 ms) in the neurostimulatory cord quadriceps, and 20 mL of 0.25% bupivacaine was applied to the nerve periphery, was performed after spinal anesthesia. Then, routine spinal anesthesia (spinal bupivacaine (15 mg) and 25 gauge spinal needle) was performed.