SINGLE SHOT FEMORAL NERVE BLOCK IN COMBINATION WITH SINGLE SHOT SCHIATIC NERVE BLOCK FOR POSTOPERATIVE ANALGESIA AFTER TOTAL KNEE REPLACEMENT

Background: The use of epidural analgesia in the management of postoperative pain following orthopedic surgeries has evolved as a critical component of a multimodal approach to achieve the goal of pain relief, early mobilization, and improved compliance with physiotherapy resulting in overall improved outcomes. Aim: The aim of this study is to compare continuous femoral nerve block with continuous epidural block technique for postoperative analgesia in patients undergoing elective total knee replacement surgery.Subjects and Methods:The patients belonging to the ASA I to III scheduled for various knee surgeries under spinal anesthesia were enrolled in this study. They were randomly divided into two equal groups of thirty-three patients each. The Group F patients received continuous femoral nerve blockade and in the Group E patients continuous epidural blocked preoperatively.Results:The analgesic efficacy of both continuous femoral nerve block and continuous epidural nerve block was equal as measured by the visual analogue scores. The incidence of Hypotension was more in the Epidural group. The adverse effects due to the Continuous Femoral Nerve block were lower in comparison with the Continuous Epidural block technique.Conclusion:Continuous femoral nerve blockade provides postoperative analgesia equivalent to that obtained with a continuous epidural blocked but with lesser side effects.

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Comparative analysis of combined spinal epidural and spinal plus single shot femoral nerve block as post-operative analgesia in total knee replacement surgery

Asian Journal of Medical Sciences ◽

10.3126/ajms.v12i7.35857 ◽

2021 ◽

Vol 12 (7) ◽

pp. 58-63

Author(s):

Shirish Mohan Mahure ◽

Ramprasad Pralhad Chavan ◽

Kalyanji Dedhiya ◽

Dnyanesh Balkrishna Amle

Keyword(s):

Total Knee Replacement ◽

Nerve Block ◽

Knee Replacement ◽

Femoral Nerve Block ◽

Femoral Nerve ◽

Single Shot ◽

Rescue Analgesia ◽

Combined Spinal Epidural ◽

Total Knee ◽

Spinal Epidural

Background: Effective anaesthesia is required to overcome complications of epidural anaesthesia and relieve the patients undergoing lower limb surgeries such as total knee replacement from severe pain. Aims and Objective: The current study was aimed to study combined spinal- epidural anaesthesia (CSEA) and spinal plus single shot femoral nerve block (SSFNB) for post-operative analgesia in total knee replacement surgeries. Materials and Methods: This prospective observational and randomized study included 60 subjects undergoing Total knee replacement which were randomized into two groups and administered combined spinal epidural block and single shot femoral nerve block as per standardised protocol for post-operative pain management. Pain as per visual analogue scale and need of rescue analgesia and other haemodynamic parameters were compared between two groups and at different time interval. Result: Two study groups were found to be matched for age, gender, weigh, height and ASA grading. SSFNB group showed significantly high VAS score at 6 Hr, need for rescue analgesia, compared to CSEA group. CSEA group had significantly high number of patients with motor block. significant difference in the variation of pulse rate was observed within both the groups. Significantly higher systolic blood pressure at 6h, 12h, 24h and 36h., diastolic blood pressure at 6h, 24h and 48h and in mean arterial pressure at 6h, 24h and 36 h was observed in SSFNB group compared to CSEA group. Conclusion: We concluded that, patients undergoing total knee replacement show better analgesia and hemodynamic stability with CSEA in comparison to SSFNB, but at the cost of more motor blockade on non-operative limb and delayed recovery.

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