Continuous psoas and sciatic block after knee arthroplasty: good effects compared to epidural analgesia or i.v. opioid analgesia: a prospective study of 63 patients.
BACKGROUND
For endoprosthetic knee surgery, intensive postoperative pain therapy is necessary. We therefore evaluated whether the combination of continuous psoas compartment and sciatic analgesia (PSC) is as effective as epidural analgesia (EPI) and whether it provides better analgesia than patient-controlled intravenous analgesia with piritramide (PCA).


METHODS
We studied 63 patients who underwent total knee arthroplasty (TKA). The PSC group received a combination of continuous psoas and sciatic nerve block, the EPI group an epidural analgesia, and the PCA group an intravenous patient-controlled piritramide pump. Pain scores, satisfaction, flexion and side effects were recorded.


RESULTS
Pain scores (0-10) were higher in the PCA group (on movement, day 1/day 2: 7.0/6.5) than in the EPI group (5.0/5.0) and the PSC group (4.0/3.5). Postoperative opioid consumption over 48 h was higher in the PCA group (51 mg) than in the EPI group (0 mg) and the PSC group (0 mg). There were no differences in functional recovery. Pruritus occurred more frequently in the PCA and EPI groups than in the PSC group. Patients receiving a PSC and EPI were more satisfied than those treated with PCA.


CONCLUSIONS
Analgesia with PSC catheters or EPI catheter is superior to PCA regarding pain levels, analgesic requirements, and patient satisfaction. There was no difference in functional outcome between the 3 groups.
Raimer
Constance
C
Universitätsklinik für Department of Anesthesiology and Intensive Care, Charité Campus Mitte, Charitéplatz 1, Berlin, DE-10117, Germany.
Priem
Kristin
K
Wiese
Andrea A
AA
Birnbaum
Juergen
J
Dirkmorfeld
Larissa M
LM
Mossner
Andrea
A
Matziolis
Georg
G
Perka
Carsten
C
Volk
Thomas
T
D000368:Aged; D000577:Amides / Q000008:administration & dosage* / Q000009:adverse effects; D015360:Analgesia, Epidural / Q000379:methods*; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy*; D017060:Patient Satisfaction; D010892:Pirinitramide / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D016658:Psoas Muscles / Q000294:innervation*; D020127:Recovery of Function; D000077212:Ropivacaine; D012584:Sciatic Nerve; D016896:Treatment Outcome
D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D010892:Pirinitramide; D000077212:Ropivacaine