The posterior lumbar plexus (psoas compartment) block and the three-in-one femoral nerve block provide similar postoperative analgesia after total knee replacement

Abstract

P Pu ur rp po os se e: : To compare the efficacy of a continuous posterior lumbar plexus (PSOAS) block to a continuous three-in-one femoral nerve (FEM) block in patients undergoing primary total knee replacement (TKR).M Me et th ho od ds s: : Sixty patients were randomly allocated to receive iv patient-controlled morphine analgesia (PCA), PCA plus a continuous FEM block with 30 mL ropivacaine 0.5% and epinephrine 1:200,000 bolus followed by an infusion of ropivacaine 0.2% at 12 mL·hr -1 for 48 hr, or PCA plus a continuous PSOAS block with the same bolus and infusion regimen as the FEM group. Postoperative morphine consumption, verbal analogue scale pain scores at rest and during physiotherapy, and evidence of sensory and motor blockades were noted. R Re es su ul lt ts s: : Both regional techniques significantly reduced 48 hr morphine consumption (FEM 37.3 ± 34.7 mg, P = 0.0002; PSOAS 36.1 ± 25.8 mg, P < 0.0001) compared to PCA (72.2 ± 26.6 mg). Pain scores at rest, six and 24 hr after TKR were lower in the FEM and PSOAS groups compared to the PCA group (P < 0.0001). Although sensory and motor blockades of the obturator nerve were achieved more often in the PSOAS group than in the FEM group (P < 0.0001), morphine consumption and pain scores did not differ between the two groups.C Co on nc cl lu us si io on n: : Both continuous PSOAS block and continous threein-one FEM block provided better analgesia than PCA but no differences were seen between the two regional techniques.

The Comparing of Ultrasound-guided Techniques: Sciatic Block with Continuous Lumbar Plexus Block or Continuous Femoral Nerve Block for Anesthesia and Analgesia of Total knee Replacement

“…McNamee et al [5] affirm that the addition of an obturator nerve block improved postoperative analgesia following total knee replacement; however, while our results show a higher rate of obturator nerve involvement in the PSOAS group, there were no differences between the two techniques in terms of VAS pain scores and total morphine consumption after TKR. In agreement with our trial, Kaloul et al [8] suggest that obturator nerve involvement does not improve postoperative pain scores after TKR; Morin et al [9] come to the same conclusion. Preliminary results by Lund et al go in the opposite direction: continuous adductor-canal-blockade may be a valuable adjunct for post-operative analgesia after major knee surgery [12].…”

“…This could *Address correspondence to this author at the Via Di S. Eufemia, 11, 00187 Rome, Italy; Tel: +39-06-6793660; Fax: +39-06-6793660; E-mail: mario.dauri@fastwebnet.it be explained considering that the three-in-one block does not involve the posterior branch of the obturator nerve [6], resulting in a less consistent blockade of this nerve than the lumbar plexus block (PSOAS) [5,7]. However, Kaloul et al [8] and Morin et al [9] found no differences in postoperative pain relief comparing continuous lumbar plexus and femoral blockades, after TKR. None of these previous studies explored intra-operative time, nor did they use ultrasoundguided techniques.…”

Eficacia analgésica de una dosis única de dexametasona perineural en el bloqueo ecoguiado del nervio femoral en cirugía de prótesis total de rodilla

“…El bloqueo lumbar no está recomendado actualmente como tratamiento del dolor agudo postoperatorio de la PTR (recomendación C, evidencia 3), pues la analgesia proporcionada es similar a la obtenida con el bloqueo femoral, pero con un índice más alto de posibles complicaciones derivadas de la técnica 98 .…”

Controle da dor pós-operatória da artroplastia total do joelho: é necessário associar o bloqueio do nervo isquiático ao bloqueio do nervo femoral?

“…They concluded that the obturator nerve does not have a significant contribution for the development of postoperative pain in TKA. Kaloul et al 27 reached to the same conclusion regarding morphine consumption using those same techniques in two groups of 20 patients. The intercurrences observed included two cases of nausea and/or vomiting, of low severity, in each group.…”