Positioning of fracture femur patients for spinal anesthesia: Femoral nerve block or intravenous fentanyl?

Objective. This study aims to compare two different methods of regional anesthesia applied for knee arthroscopy in terms of patient and surgeon satisfaction. Materials and Methods. Eighty patients who underwent knee arthroscopy either with spinal anesthesia (SA) or unilateral sciatic and femoral nerve block (SFNB) were included in the study. A nurse conducted a blind study questionnaire to assess the surgeon and patient satisfaction from anesthesia performed at the end of the surgery. Pain score, demographical data, duration of surgery, motor and sensory block duration, time of first rescue analgesia were recorded and analyzed statistically. Results. A statistically significant difference was found between the patient (p = 0.001; p <0.01) and surgeon (p = 0.022; p <0.05) satisfaction rates, these being lower in the group with SFNB comparable to patients with spinal anesthesia. There was a statistically significant difference between the first analgesic requirements of the patients according to the groups (p = 0.001; p <0.01). The first analgesic requirement of the patients who received SFNB was later than in the case of patients who received spinal anesthesia. Conclusions. Patient and surgeon satisfaction with SA was significantly higher than SFNB. The peripheral nerve blocks are inadequate for patient and surgeon satisfaction for knee arthroscopy compared to SA.

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Ultrasound Guided Femoral Nerve Block with Bupivacaine versus Bupivacaine and Tramadol for Postoperative Analgesia in Patients Undergoing Total Knee Arthroplasty under Spinal Anesthesia

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2021/v33i2131130 ◽

2021 ◽

pp. 23-32

Author(s):

Mohammad Mostafa Abo Farrag ◽

Laila Elahwal ◽

Hesham Mohammad Maroof ElDomairy ◽

Mohammad Ibrahem Okab

Keyword(s):

Total Knee Arthroplasty ◽

Spinal Anesthesia ◽

Nerve Block ◽

Knee Arthroplasty ◽

Postoperative Analgesia ◽

Femoral Nerve Block ◽

Femoral Nerve ◽

Ultrasound Guided ◽

Group I ◽

Total Knee

Background: Effective pain control in Total knee arthroplasty (TKA) is important for optimizing the rehabilitation process in order to achieve patient satisfaction with a good functional outcome as well as reduce hospitalization duration and costs. Combined use of aesthetic with tramadol has been reported to achieve a longer duration of sensory and motor block. The aim of this study is to evaluate the quality and duration of postoperative analgesia produced by ultrasound guided femoral nerve block (FNB) by bupivacaine versus (bupivacaine & tramadol) in patients undergoing total knee arthroplasty under spinal anesthesia. Methods: This prospective randomized controlled double blinded study was carried out on 60 patients aged above 50 years; American Society of Anesthesiologists physical status (ASA) I-III scheduled for total knee arthroplasty under spinal anesthesia. Patients were randomized to one of two equal groups: Group I control (C): received FNB with 30 ml 0.25% bupivacaine. Group II tramadol (T): received FNB with 30ml 0.25% bupivacaine and 100 mg tramadol. Results: Postoperative heart rate was significantly increased in group C than group T at 8h, 12h, 16h and 24h. Postoperative mean arterial blood pressure was significantly increased in group C than group T at 6h, 8h, 12h, 16h and 24h. There were 30 (100%) patients required rescue analgesia in group C and 19 (63.33%) patients in group T which was increased significantly in group C than group T. The time to first analgesic requirement was significantly decreased in group C than group T. Total morphine consumption was increased significantly in group C than group T. VAS was increased significantly in group C than group T at 6, 8, 12, 16 and 24 hours. Adverse effects were insignificantly different between both groups. Conclusion: Adding tramadol (100 mg) to 0.25% bupivacaine (to a volume of 30 ml) during US guided FNB of TKA under spinal anesthesia was associated with better postoperative analgesia when compared with 0.25% bupivacaine alone.

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