[Epidural analgesia versus femoral or femoral-sciatic nerve block after total knee replacement: comparison of efficacy and safety].
OBJECTIVE
Pain after total knee replacement surgery is intense. The aim of this study was to compare 3 techniques for providing postoperative analgesia (epidural analgesia, femoral nerve block, and a combined femoral-sciatic nerve block) in total knee arthroplasty.


METHODS
Observational study of 1550 elective primary unilateral total knee replacement operations. The safety and efficacy of the following 3 techniques were compared: epidural analgesia, femoral nerve block, and femoral-sciatic nerve block. Demographic, anesthetic, and surgical data were recorded. Study variables included pain intensity on a visual analog scale every 4 hours, need for rescue analgesia (morphine), complications and adverse events within 5 postoperative days.


RESULTS
No significant differences were found in demographic, anesthetic, or surgical variables. In the first 24 hours after surgery, pain intensity was significantly less for patients who received a femoral-sciatic nerve block. The mean levels of morphine consumption in the first 96 hours after surgery were similar in the femoral-sciatic nerve block group (3.18 mg) and the epidural analgesia group (3.19 mg); morphine consumption in the femoral block group was significantly higher (4.51 mg). Epidural analgesia was associated with the highest rate of complications (17%).


CONCLUSIONS
A sciatic nerve block combined with a femoral nerve block attenuates pain more effectively and is associated with less postoperative morphine consumption in comparison with a femoral nerve block alone. Peripheral nerve block techniques have fewer adverse side effects than epidural analgesia.
Santiveri Papiol
X
X
Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Mar-Esperança, Barcelona. 90409@imas.imim.es
Castillo Monsegur
J
J
Bisbe Vives
E
E
Ginés Cespedosa
A
A
Bartrons Vilarnau
R
R
Montes Pérez
A
A
Escolano Villén
F
F
D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000706:statistics & numerical data; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D019645:Arthroplasty, Replacement, Knee; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005267:Femoral Nerve; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D009294:Narcotics / Q000627:therapeutic use; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced; D011446:Prospective Studies; D012584:Sciatic Nerve; D016055:Urinary Retention / Q000139:chemically induced
D000779:Anesthetics, Local; D009294:Narcotics; D009020:Morphine; D002045:Bupivacaine