Different Regional Anesthetic Techniques in Knee Surgery

Abstract

Large proportion of patients undergoing to do knee surgeries do not receive adequate postoperative analgesia. Postoperative pain is the leading cause of unplanned hospital admissions following ambulatory surgery and a major source of dissatisfaction with perioperative outcome. Perioperative pain can be abolished by Neuraxial block or peripheral nerve block. Neuraxial block involves: spinal, epidural, caudal block. Using long-acting local anesthetics, peripheral nerve blocks can be used to provide an excellent anesthesia and postoperative analgesia. Additionally, a catheter for continuous infusion of local anesthetics can be inserted perineurally to extend the analgesia beyond the duration of the single shot blocks. This assay will discuss the advantages and limitations of Neuraxial blocks and various nerve block techniques when used for perioperative and postoperative pain management for different types of knee surgeries. Depending on the extent and type of knee surgery, the lumbar plexus block, femoral block, sciatic block technique can all be used to provide anesthesia and perioperative analgesia after knee surgery. In addition to being good alternatives to central neural blockade for patients who will be anticoagulated after surgery, these techniques provide unilateral analgesia with far fewer side-effects than epidural analgesia. The femoral nerve block provides better analgesia for the first 24 hours after outpatient arthroscopic anterior cruciate ligament repair, the requirements for analgesic therapy and pain scores were significantly lower in the group that received femoral block. The femoral block is especially appealing in outpatients because its use is associated with longer duration of analgesia and fewer complications than neuraxial anesthesia. For example, pain after total knee replacement (TKR) is often difficult to control using only IV opioids. Femoral, combined femoral-sciatic block in patients after total knee replacement control this pain. Pain scores at rest and morphine consumption were significantly lower for at least 8 hours after transfer to the ward in the groups receiving peripheral nerve blocks. In contrast, it is found that blocking S1 as well as the femoral, lateral femoral cutaneous, and obturator nerve was beneficial in enhancing analgesia after TKR. Unfortunately, single-shot blocks eventually resolve by the morning after surgery, resulting in the return of pain. Thus, an ability to extend analgesia beyond the first 12-24 hours as well as the ability to re-bolus the catheter before physical therapy appears to have significant benefits. Finally our conclusion is that "3-in-1" block and epidural analgesia provided best pain control after knee surgeries.