Combined femoral sciatic block vs. epidural analgesia after total knee replacement

Abstract

Background: Surgeries of the knee are associated with moderate to severe postoperative pain, so these procedures are better to be done under regional anesthetic techniques which reduce neuroendocrinal stress responses, central sensitization of the nervous system and muscle spasms which occur in response to painful stimuli. Aim of the Work: to compare between epidural anesthesia and femoral and sciatic nerves block in adult patients undergoing total knee replacement including comparison of analgesic efficacy, side-effects, and complications. Patients and Methods: The study was performed upon 30 patients, and randomly distributed among two groups: Group A: 15 patients received lumbar epidural anesthesia followed by general anesthesia and Group B: 15 patients received femoral and sciatic nerves block followed by general anesthesia. For each patient, the following data were collected: age, sex, weight, height, ASA, duration of surgery, hemodynamic changes, incidence of postoperative complications, pain scores, morphine consumption, rehabilitation indices and duration of hospital stay. Results: showed that performing femoral and sciatic nerves block provided effective unilateral analgesia, equivalent rehabilitation and duration of hospital stay in addition to fewer complications in comparison to epidural anesthesia such as hypotension, postoperative vomiting and urinary retention. Conclusion: Femoral and sciatic block technique placed under ultra-sound guidance for postoperative pain control provides equivalent analgesia, opioid consumption, postoperative rehabilitation and hospital stay with a lower incidence of hemodynamic side effects when compared to epidural analgesia in patients undergoing moderate to major knee surgeries. Key words: femoral sciatic block, epidural analgesia, total knee replacement