Postoperative analgesia and functional recovery after total-knee replacement: comparison of a continuous posterior lumbar plexus (psoas compartment) block, a continuous femoral nerve block, and the combination of a continuous femoral and sciatic nerve block.
OBJECTIVE
Continuous femoral nerve block is a well-accepted technique for regional analgesia after total-knee replacement. However, many patients still experience considerable pain at the popliteal space and at the medial aspect of the knee. The goal of this study is to evaluate whether a psoas compartment catheter provides better postoperative analgesia than a femoral nerve catheter does and whether it is as effective as the combination of a femoral and a sciatic nerve catheter and, thus, improves functional outcome.


METHODS
Ninety patients who underwent total-knee replacement under standardized general anesthesia participated in this prospective randomized study. Group FEM received a continuous femoral nerve block, group FEM/SCI received a combination of a femoral and a sciatic continuous nerve block, and group PSOAS received a continuous psoas compartment block. Patient-controlled analgesia with piritramide was available for 48 hours. Maximal bending and extending of the knee and walking distance was assessed during the first 7 days. A standardized telephone survey was conducted after 9 to 12 months to evaluate residual pain and functional outcome.


RESULTS
Postoperative opioid consumption during 48 hours was significantly less in the FEM/SCI group (median: 18 mg; 25th/75th percentile: 6/40) compared with the FEM group (49 mg; 25/66) and the PSOAS group (44 mg; 30/62) (P =.002). Postoperative pain scores were not different, and no differences occurred with respect to short-term or long-term functional outcome.


CONCLUSIONS
The FEM/SCI catheter is superior to FEM and PSOAS catheter with respect to reduced analgesic requirements after total-knee replacement, but functional outcome does not differ with those 3 continuous regional analgesia techniques.
Morin
Astrid M
AM
Department of Anesthesiology and Critical Care Medicine, Philipps-University Marburg, Baldingerstrasse, D-35043 Marburg, Germany. morin@mailer.uni-marburg.de
Kratz
Caroline D
CD
Eberhart
Leopold H J
LH
Dinges
Gerhard
G
Heider
Elke
E
Schwarz
Nadine
N
Eisenhardt
Gudrun
G
Geldner
Götz
G
Wulf
Hinnerk
H
D000368:Aged; D000704:Analysis of Variance; D019645:Arthroplasty, Replacement, Knee / Q000379:methods / Q000534:rehabilitation*; D004359:Drug Therapy, Combination; D005260:Female; D005267:Femoral Nerve / Q000187:drug effects*; D005500:Follow-Up Studies; D006801:Humans; D008160:Lumbosacral Plexus / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000187:drug effects; D020127:Recovery of Function / Q000187:drug effects*; D012584:Sciatic Nerve / Q000187:drug effects*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome