Comparison Between Ultrasound-Guided Sciatic-Femoral Nerve Block and Unilateral Spinal Anaesthesia for Patients Undergoing Total Knee Arthroplasty; A Prospective Randomized Controlled Trial
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Keywords
Unilateral Spinal Anaesthesia, Femoral Nerve Block, Sciatic Nerve Block, Total Knee Arthroplasty
Abstract
Background: Selective unilateral spinal anaesthesia has many benefits, like early ambulation and more hemodynamic stability. Sciatic-femoral nerve block provides early recovery of the motor, urinary and GIT function, besides prolonged postoperative analgesia. Aim: is to compare an ultrasound-guided combined sciatic–femoral nerve block (USFB) and unilateral spinal anaesthesia (USA) in cases undergoing total knee arthroplasty (TKA).
Methods: The study is a randomized, controlled, single-blind prospective study. Ninety patients were included and divided into two equal groups. USFB group received a 30 ml mixture consisting of 7.5 ml of 2.0% lidocaine, 15 ml of 0.25% bupivacaine and 7.5 ml of saline (15 ml for the femoral and 15 ml for the sciatic nerve block). USA Group received 2.2 ml (12 mg) of 0.5% levobupivacaine.
Results: visual analogue scale (VAS) recordings were significantly lower among the USFB group, compared to the USA group at 4, 8, 12 and 16 hours postoperatively. The duration of the first request of analgesia was significantly longer in the USFB group in comparison to the USA group (347.2 vs 182.63 minutes; P<0.001), respectively. The USA group showed shorter onset and faster sensory and motor block recovery, compared to the USFB group. No significant difference was reported between the two groups regarding the hemodynamic parameters either intra- or post-operatively. No serious complications were noticed in both groups.
Conclusion: Both USA and USFB resulted in comparable adequate intraoperative anaesthesia with stable hemodynamics and minimal side effects. USFB was superior to the USA regarding postoperative analgesia.
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