Combined Ultrasound-Guided Femoral and Sciatic Nerve Block Efficacy in Arthroscopic Knee Surgeries Anesthesia and Post-Operative Analgesia
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- Category: Vol. 84, December 2016
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Combined Ultrasound-Guided Femoral and Sciatic Nerve Block Efficacy in Arthroscopic Knee Surgeries Anesthesia and Post-Operative Analgesia, SAAD E. AHMED, NEVAN A. MEKAWY, MOHAMMED BELETA, REHAM MAGDY, MOHAMMED DOULA and MOHAMED A. HASSAN
Abstract
Background: Most orthopedic surgeries is performed on extremities (arms and legs), the innervations of which is derived centrally from the spinal nerves. These nerves coalesce into plexuses, and finally divide into terminal nerves supplying the bones and muscles and innervating the skin of the arm and leg. At certain points along their path these nerves can easily be identified and blocked with local anesthetic, achieving analgesia and anesthesia.
Objective: Sciatic nerve block guided ultrasound in com-bination with femoral nerve block has been suggested to be useful in relieving pain during and after knee arthroscopic surgery. We discuss multiple approaches of sciatic nerve block guided ultrasound to evaluate their efficacy in combination with femoral nerve block as analgesia in knee arthroscopic surgery.
Methods: For two years, between 2013-2015 in Kasr Al-Ainy University Hospital (264) patients, ASA I, II or III of both gender and age between 20 and 50 years, undergoing unilateral knee arthroscopic surgeries under general anesthesia, using femoral nerve block plus sciatic nerve block guided ultrasound as analgesia, were enrolled in a prospective, randomized, double blind study.
Patients were divided into three equal groups, (88) patients each. All the patients received femoral nerve block guided ultrasound in addition to sciatic nerve block guided ultrasound either posterior sub-gluteal approach (posterior group), anterior approach (anterior group), or medial mid-thigh approach (medial group).
Patients were assessed as regards the onset, duration and intensity of the sensory and motor blocks; post-operative knee pain assessment for 12 hour and also the patient satisfaction were investigated.
Result: It was found that the only 7 patients of the posterior subgluteal approach, 8 patients of the anterior group and 12 patients of medial mid-thigh group reported as failure due to delayed loss of sensory loss in all dermatomes after 30 minutes, the onset of sensory loss in all dermatomes of the lower limb showed no significant differences between all groups. Regard the intensity of sensory loss showed significant difference in posterior group, it showed 16 patients with no pain after 30 minute and only 7 patients suffered from severe pain but there were no significant differences in both anterior and mid-thigh groups, and there were no significant difference between all groups in the duration of sensory block.
Concerning motor assessment there were no significant difference between all groups regarding onset and duration of the block, but in the motor intensity of block the posterior group showed statistically different result as 16 patients couldn't flex their knee and ankle, in comparison to 8 patients in anterior group and only 7 patients in mid-thigh group.
As postoperative analgesia recording just after the finishing of the operation there were significant difference between the three groups on visual analogue score, in the posterior group 12 patients gave 0 score, the anterior group 8 patients gave 0 and only 7 patients in mid-thigh group gave 0 score, but when observed 6 and 12 hours after the operation there were no statistical difference between groups.
Observing patients satisfaction resulted in significant differences between the three groups as 19 patients in anterior group reported excellent satisfaction, 14 patients in posterior group but only 7 patients in mid-thigh group.
Conclusion: All approaches is considered as effective analgesia in combination with general anesthesia during arthroscopic knee surgeries, these blocks provided good or excellent postoperative analgesia for all patients in the different groups. The posterior subgluteal approach is easier with higher success rate and it gave tense sensory and motor block and great post-operative analgesia. The anterior approach is difficult and need high experience especially in obese patients. The medial mid-thigh approach was the least performed technique. However, it is useful in patients in supine position, and easy to be done in thin patients, but this technique showed difficulty in obese patients due to limitation of rotation the leg. Patients were satisfied using anterior approach.