Effects of adding single Injection Femoral and Sciatic nerve block, Intrathecal Morphine and Spinal anesthesia alone on Postoperative Pain After Total Knee arthroplasty
Keywords:
Femoral Nerve Block, Sciatic Nerve Block, Intrathecal MophineAbstract
Total knee arthroplasty(TKA) produces severe postoperative pain.Peripheral nerve blocks can be used as analgesic adjuncts for TKA. Objective: To investigate pain control for patients undergoing total knee arthroplasty, comparing those receiving femoral and sciatic nerve block before spinal anesthesia to those receiving intrathecal morphine and to those receiving spinal anesthesia alone. Method: In this prospective, randomized controlled study, sixty patients undergoing total knee arthroplasty were randomized into 3 group: Group 1 received both femoral and sciatic nerve blocks before spinal anesthesia (n=20), Group 2 received morphine 0.2 mg. intrathecal (n=20) and Group 3 received spinal anesthesia technique alone (n=20),Intravenous morphine use, visual analog pain scale scores, time at first dose morphine use postoperative and side effects were measured for 48 hours after surgery. Result: There were no significant difference in any outcome variable. Mean pain score at 4, 8, 12, 16 and 24 hours postoperative in Group I were 3.5, 3.6, 3.2, 2.9 and 2.1, Group 2:3.2, 3.9, 3.8, 3.2 and 3.0, Group 3: 4.8,4.1, 4.6, 4.3 and 3.5.Patients in Group 1 and 2 reported similar pain score postoperative but significantly lower pain scores than those in Group 3.Time at first dose morphine used was prolong in patients Group 2.Morphine used was significantly lower in the femoral and sciatic nerve blocks group for 48 hours. The nausea and vomiting was significantly found in intrathecal morphine group. Conclusion: Comparison with intrathecal morphine, a single injection femoral and sciatic nerve block provides equivalent analgesia but with a significant reduction in side effects and total morphine used for patients having TKA under bupivacaine intrathecal anesthesia. The analgesic efficacy of femoral and sciatic nerve blocks group was similar to that of intrathecal morphine but reduced side effects and morphine used 48 hours postoperative.
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