Analgesia effect of dexamethasone combined with dexmedetomidine on femoral nerve block with ropivacaine after total knee replacement in elderly patients / 药学实践杂志

Objective To observe the analgesia effect of dexamethasone combined with dexmedetomidine on femoral nerve block with ropivacaine after total knee replacement in elderly patients. Methods 96 elderly patients undergoing total knee replacement with femoral nerve block analgesia from January 2019 to December 2020 in the hospital were enrolled in the study. Patients were divided into control group (C), dexamethasone group (E1), dexmedetomidine group (E2) and dexamethasone combined with dexmedetomidine group (E3) according to nerve block drug formulation. The general data and operation condition were collected, the VAS score at 6 h, 12 h, 24 h, 48 h and the Ramsay sedation score at 6 h after surgery were compared, the postoperative morphine consumption and duration of analgesia were analyzed, and the incidence of adverse reactions after operation was observed. Results Patients in four groups showed no significant differences in general data and operation time. The VAS score and Ramsay score at 6 h postoperatively in E2 and E3 were significantly lower than that in C, while there were no significant differences in VAS score at 24 h and 48 h postoperatively among four groups. Postoperative morphine consumption in E2 and E3 was significantly lower, and the duration of analgesia in E1, E2 and E3 was significantly longer than that in C. There was no statistical difference in the incidence of respiratory depression, nausea, vomiting, dizziness and other adverse reactions after operation among four groups. Conclusion Dexamethasone combined with dexmedetomidine could enhance the analgesic effect of femoral nerve block with ropivacaine in elderly patients after total knee replacement without increasing the adverse reactions, which would be both safe and effective.

Postoperative analgesic efficacy of nabuprofen combined with femoral nerve block in older adult patients subjected to knee arthroplasty / 中国基层医药

Objective:To investigate the postoperative analgesic efficacy of nabuprofen combined with femoral nerve block in older adult patients subjected to knee arthroplasty and its effects on cognitive function and serum S-100β protein level.Methods:Ninety-one older adult patients subjected to knee arthroplasty between March 2018 and March 2020 in Zhoushan Hospital of Traditional Chinese Medicine were included in this study. They were randomly divided into observation ( n = 45) and control ( n = 46) groups. Patients in both groups received femoral nerve block and catheterization. Naborphine and equal amount of 0.9% sodium chloride injection were intravenously administered in the observation and control groups, respectively for postoperative analgesia. Before and after surgery, Mini-Mental State Examination (MMSE) score, S-100β protein level and Visual Analogue Scale score, and adverse reactions were compared between the observation and control groups. Results:Before surgery, there was no significant difference in MMSE score between the two groups ( P > 0.05). At 3 days after surgery, MMSE score in each group was significantly decreased compared with before surgery (both P < 0.05). At 3 days after surgery, MMSE score in the observation group was significantly higher than that in the control group [(25.34 ± 1.31) points vs. (23.67 ± 1.53) points, t = 5.34, P < 0.05]. Before surgery, there was no significant difference in serum S-100β protein level between the two groups ( P > 0.05). At 1 and 3 days after surgery, serum S-100β protein level in each group was significantly increased compared with before surgery (both P < 0.05). At 7 days after surgery, serum S-100β protein level in each group recovered to pre-operative level. At 1 and 3 days after surgery, serum S-100β protein level in the observation group was significantly lower than that in the control group ( t = 10.20, 9.21, both P < 0.05). At 1, 3, 6, 12 and 24 hours after surgery, the Visual Analogue Scale score in the observation group was (1.14 ± 0.22) points, (1.43 ± 0.25) points, (1.87 ± 0.21) points, (3.56 ± 0.20) points, and (2.63 ± 0.23) points respectively, which was significantly lower than that in the control group [(2.53 ± 0.24) points, (2.53 ± 0.24) points, (3.56 ± 0.20) points, (3.98 ± 0.25) points, (4.23 ± 0.21) points, t = 5.10, 8.15, 9.41, 10.18, 11.42, all P < 0.05]. The incidence of adverse reactions in the observation group was significantly lower than that in the control group [13.33% (6/45) vs. 30.43% (14/46), χ2 = 3.88, P = 0.049]. Conclusion:Naborphine combined with femoral nerve block can effectively improve the postoperative cognitive function of older adult patients undergoing knee arthroplasty, provides good postoperative analgesia, and is highly safe.

Analgesic effect of cocktail therapy combined with femoral nerve block on total knee arthroplasty / 中国组织工程研究

BACKGROUND: Total knee arthroplasty is an important measure to save the function of knee joint, but the postoperative pain caused great pain to patients. On the background of multimodal analgesia, cocktail therapy and femoral nerve block are widely used in clinic, and the analgesic effect is exact; however, the analgesic effect and safety of the two methods used together are unknown, so more clinical evidence is needed. OBJECTIVE: To study the effect and safety of analgesic and functional recovery of cocktail therapy combined with femoral nerve block after total knee arthroplasty. METHODS: Totally 100 patients undergoing primary unilateral total knee arthroplasty were enrolled. One hundred patients were randomly divided into two groups (n=50 per group) according to the table of random numbers. Group A was given cocktail therapy combined with femoral nerve block; group B received the injection of same volume of normal saline surrounding the knee joint combined with femoral nerve block. The postoperative resting-state visual analogue scale score, knee joint range of motion, global pain scale, and incidences of adverse reactions were compared between groups. The time and frequency of analgesic drugs were recorded. RESULTS AND CONCLUSION: (1) The postoperative visual analogue scale score at rest in the group A was significantly lower than that in the group B at 24, 36 and 48 hours postoperatively (P < 0.05). The scores at 12 and 72 hours did not differ significantly between groups (P < 0.05). (2) The knee joint range of motion on postoperative 1 and 3 days in the group A was significantly higher than that in the group B (P < 0.05), and no significant difference was detected at 14 days, 1 and 3 months postoperatively (P < 0.05). (3) At 3 months after operation, there was no significant difference in the Global Pain Scale between the two groups (P < 0.05). (4) There was no significant difference in incidences of adverse reactions and additional analgesics between the two groups (P < 0.05). (5) In summary, cocktail therapy combined with femoral nerve block can relieve the early resting pain after total knee arthroplasty, and improve the activity of knee joint in the early stage, which is safe and effective.

Comparison between subarachnoid morphine and femoral nerve block for analgesia after knee ligament reconstruction: a randomized clinical trial / Comparação entre morfina subaracnoidea e bloqueio do nervo femoral para analgesia após reconstrução ligamentar de joelho: estudo clínico randomizado

Abstract Background and objectives There are no consensus of the ideal technique to provide analgesia in knee ligament reconstructions. The aim of this study was to compare the intensity of postoperative pain in these patients under different modalities of analgesia. Method Randomized and controlled clinical trial of patients undergoing reconstruction of the Anterior Cruciate Ligament (ACL) with flexor tendons between December 2013 and 2014. All patients underwent spinal anesthesia and rescue analgesia with tramadol. The groups C, M, R0,375 and R0,25 was compared with only the previously described technique, subarachnoid morphine (100░µg), or Femoral Nerve Block (BNF) with 25░mL of 0.375% ropivacaine and 0.25%, respectively. Pain intensity at 6, 12 and 24░hours, age, sex, rescue analgesia, adverse reactions and satisfaction were evaluated. Results Among the 83 eligible patients, a predominance of males (85.7%) was observed, between 28 and 31 years. The group C requested more opioid (27.3%) than the other groups, without significance when compared. There were no significant differences in pain intensity at 6, 12 and 24░hours. There was a higher incidence of urinary retention in the M group (23.8%) than in the R0,375 (0%) and prolonged quadriceps motor block in the R0,375 group (30%) than in the M and C groups (0%), with statistical significance (p░<░0.05). Conclusion There was no difference in the intensity of postoperative pain in patients submitted to ACL reconstruction with flexor tendons under the analgesic modalities evaluated, despite the predominance of urinary retention in the M group and motor block in the R0,375 group.

Resumo Justificativa e objetivos Não há consenso sobre qual é a técnica ideal para prover analgesia em reconstruções ligamentares de joelho. Objetivou‐se comparar a intensidade da dor pós‐operatória desses pacientes sob diferentes modalidades de analgesia. Método Ensaio clínico randomizado e controlado de pacientes submetidos à reconstrução do ligamento cruzado anterior com tendões flexores entre dezembro de 2013 e 2014. Todos os pacientes foram submetidos a raquianestesia e analgesia de resgate com tramadol. Compararam‐se os grupos C, M, R0,375 e R0,25; aos quais se ofertou apenas a técnica anteriormente descrita, morfina subaracnóidea (100 µg) ou bloqueio de nervo femoral com 25 mL de ropivacaína 0,375% e 0,25%, respectivamente. Avaliou‐se intensidade da dor em 6, 12 e 24 horas, idade, sexo, analgesia de resgate, reações adversas e satisfação. Resultados Entre os 83 pacientes elegíveis, observou‐se predomínio do sexo masculino (85,7%) entre 28 e 31 anos. O Grupo C solicitou mais opioide (27,3%) do que os demais grupos, sem significância quando comparados. Não houve diferenças significativas na intensidade da dor em 6, 12 e 24 horas. Houve maior incidência de retenção urinária no Grupo M (23,8%) do que no R0,375 (0%) e de bloqueio motor prolongado do quadríceps no Grupo R0,375 (30%) do que nos Grupos M e C (0%), com significância estatística (p< 0,05). Conclusão Não houve diferença na intensidade da dor pós‐operatória nos pacientes submetidos à reconstrução de ligamento cruzado anterior com tendões flexores sob as modalidades analgésicas avaliadas, apesar do predomínio de retenção urinária no Grupo M e bloqueio motor no Grupo R0,375.

Femoral Nerve in Femoral Triangle: A Morphometric Study with Clinical Relevance

Background: Femoral nerve is a nerve of choice forfemoral nerve blockade. It enters the femoral triangle atthe midinguinal point. However, this point of entry neednot be the same always. Aim and Objectives: This studyis aimed at measuring the morphometry of the femoralnerve with the help of bony landmarks. Material andmethods: Forty adult lower limbs were dissected andthe morphometry of the femoral nerve was studied.Results: The mean distance from the Anterior SuperiorIliac Spine (ASIS) to the pubic tubercle was 12.66 ±1.48 cm. We found the FN from the ASIS at a meandistance of 6.38 ± 1.45 cm. Also, the FN was at a meandistance of 6.76 ± 1.12 cm from the pubic tubercle. Themean length of the FN trunk below the inguinalligament, i.e., in the femoral triangle before the divisionwas 2.19 ± 0.34 cm. However, in 8 lower limbs, the FNtrunk was divided before entering the femoral triangle.Conclusion: The findings of our study serve as anenabling guide to the surgeons, neurologists andanesthetist's in detecting the FN for various clinical andsurgical procedures.

Comparative Evaluation of Femoral Nerve Block & Intravenous Fentanly for Positioning During Spinal Anesthesia in Surgery of Femur Fractures

Introduction: Femur fractures configure an important publichealth issue and are associated with high mortality taxes andlose of functionality. Study aimed to compare the analgesiceffects of FNB with intravenous (IV) fentanyl prior topositioning for spinal block in patients with fractured femur.Material and Methods: Sixty patients scheduled for fracturedfemur surgery under spinal block. They were grouped as FNBgroup (n=30) and a fentanyl group (n=30). A spinal block wasperformed. Pain scores 15 minutes after analgesia and duringpositioning were recorded. A numeric rating pain scale (0 =no pain, 10 = maximal pain) was used. Additional fentanylrequirement during positioning and satisfaction with patientposition maintained for spinal block (yes = satisfactory, no =not satisfactory) were also recorded.Results: Base line values for Heart Rate (HR), Mean ArterialPressure (MAP) and type of surgery were comparable inboth the groups. We found an insignificant difference in HR(P>0.001) among the groups and a significantly lower MAPin FENT group (P = 0.0090). SpO2 was significantly lower inFENT group (P < 0.001).Conclusion: Femoral nerve block lowers pain and the needfor supplementary analgesia requirement

Concentración de bupivacaína y preservación de fuerza de cuádriceps en bloqueo femoral para artroplastía total de rodilla / Bupivacaine concentration and quadriceps strength preservation in femoral nerve block for total

INTRODUCTION: The commonly used concentrations of local anesthetics (LA) for femoral nerve block (FNB) cause a significant decrease in the quadriceps strength (QS), limiting physiotherapy and determining a risk factor for patient's falls. The use of more dilute solutions could determine the preservation of motor function without impairing analgesia. METHODS: Five patients scheduled for total knee arthroplasty (TKA) received a preoperative FNB with 20 mL of bupivacaine in decreasing concentrations (0.0875%, 0.075%, 0.0625%, 0.050%, 0.0375%). Sensory block to cold in the anterior knee region, QS, surface electromyography (SEMG) of vastus lateralis (VL), vastus medialis (VM) and rectus femoris (RF) plus were recorded before and 30 minutes after the blockage. Posteriorly, the clinical data of 20 patients who underwent TKA and received a continuous femoral nerve block (CFNB) with bupivacaine in the most dilute concentration that granted sensory blockade and significantly preserved the QS in the previous analysis were retrospectively analyzed. Postoperative pain at 24 and 48 hours, morphine consumption at 24 hours, the ability to successfully perform physiotherapy on the first postoperative day (POD) and reports of falls were rescued from the patients' files. Finally, seventy-five patients that underwent TKA during 2018 who received a CFNB with a similar dilution, but using levobupivacaine, were also retrospectively analyzed. Postoperative pain, need for advanced rescue analgesia, ability to perform physiotherapy, CFNB related complications and reports of patients falls during the first 72 hours post-surgery were obtained. RESULTS: Biomechanical study: of the 5 concentrations analyzed, either 0.050% or 0.0375% bupivacaine were adequate producing sensory block and preserving 94% and 100% of the basal QS, respectively. With both concentrations, the SEMG showed a similar range of activation with respect to baseline values. Bupivacaine case series: Twenty patients undergoing TKA received a 5-8 mL/hr infusion of 0.037% bupivacaine. The average consumption of morphine at 24 hours was 3.9 (3.6) mg. The median [IQR] of dynamic postoperative pain at 24 and 48 hours was 3 [1-4] and 3 [2-5]. All patients had adequate active joint ranges at 24 hours and physiotherapy was not limited by significant motor block. No falls were reported during the stay. Levobupivacaine case series: seventy-five patients undergoing TKA received a 5-8 mL/hr infusion of 0.037% levobupivacaine. The median [IQR] of at rest (R) and dynamic (D) postoperative pain at 24, 48 and 72 hours were R24: 0 [0-3]; D24: 3 [1-5]; R48: 0 [0-2]; D48: 3 [1.5-5]; R72: 0 [0-1]; D72: 3 [1-4]. 21% of patients required adding a PCA mode to the CFNB and a 7% a morphine PCA. On POD 1, 4% of patients were not able to adequately perform rehabilitation. On POD 2 and 3, all patients had adequate active joint ranges and physiotherapy was not limited by significant motor block. There were also no falls during hospitalization. CONCLUSIONS: The use of diluted solutions of bupivacaine and levobupivacaine for CFNB may represent a good alternative for TKA postoperative analgesia while avoiding significant quadriceps paresis. Additional studies are necessary to determine the ideal concentration and administration regimen to then compare with other quadriceps sparing analgesic alternatives.

INTRODUCCIÓN: Las concentraciones habituales de anestésicos locales (AL) utilizadas para el bloqueo del nervio femoral (BNF) provocan una disminución significativa de la fuerza del cuádriceps (FC), limitando la fisioterapia y constituyendo un factor de riesgo de caídas de pacientes. El uso de soluciones más diluidas podría determinar preservación de la función motora sin perjudicar la analgesia. MÉTODOS: Cinco pacientes programados para artroplastía total de rodilla (ATR) recibieron un BNF preoperatorio con 20 mL de bupivacaína en concentraciones decrecientes (0,0875%, 0,075%, 0,0625%, 0,050%, 0,0375%). Se registró la FC, electromiografía de superficie (EMGS) de vasto lateral (VL), vasto medial (VM) y recto femoral (RF) y el bloqueo sensitivo al frío antes y 30 minutos después del bloqueo. Posteriormente, se analizó retrospectivamente 20 casos sometidos a ATR que recibieron un bloqueo continuo del nervio femoral (BCNF) con bupivacaína en la concentración más diluida que otorgó bloqueo sensitivo y preservó significativamente la fuerza basal del cuádriceps durante el análisis anterior. El dolor postoperatorio a las 24 y 48 horas, el consumo de morfina las primeras 24 horas, la capacidad de realizar con éxito la fisioterapia el primer día postoperatorio (DPO) y reporte de caídas fueron rescatados de los expedientes. Por último, también se analizó retrospectivamente un grupo de 75 pacientes sometidos a ATR durante el 2018 y que recibieron un BCNF con una dilución similar, pero de levobupivacaína. Se obtuvieron datos de dolor, requerimientos de rescate analgésico, capacidad de realizar rehabilitación, complicaciones del BCNF y reporte de caídas durante las primeras 72 horas postoperatorias. RESULTADOS: Estudio biomecánico: de las 5 concentraciones analizadas, tanto bupivacaína 0,05% como 0,0375% produjeron adecuado bloqueo sensorial preservando el 94% y el 100% de la FC, respectivamente. Con ambas concentraciones la EMGS mostró similar rango de activación respecto a valores basales. Serie de casos con bupivacaína: veinte pacientes sometidos a ATR recibieron una infusión de bupivacaína 0,037% a 5-8 mL/h. El consumo promedio de morfina a las 24 horas fue 3,9 (3,6) mg. La mediana [RIC] del dolor dinámico postoperatorio a las 24 y 48 horas fue 3 [1-4] y 3 [2-5]. Todos los pacientes tuvieron rangos articulares activos adecuados a las 24 horas y la fisioterapia no fue limitada por bloqueo motor significativo. No se registraron caídas durante la hospitalización. Serie de casos levobupivacaína: setenta y cinco pacientes sometidos a ATR recibieron una infusión de levobupivacaína 0,037% a 5-8 mL/h. La mediana [RIC] de dolor postoperatorio en reposo (R) y dinámico (D) a las 24, 48 y 72 horas fue R24: 0 [0-3]; D24: 3 [1-5]; R48: 0 [0-2]; D48: 3 [1.5-5]; R72: 0 [0-1]; D72: 3 [1-4]. Un 21% requirió agregar modo PCA al BCNF y 7% una PCA de morfina. En DPO 1, un 4% de pacientes no pudo realizar adecuadamente la rehabilitación. En DPO 2 y 3 todos los pacientes tuvieron rangos articulares activos adecuados y fisioterapia no fue limitada por bloqueo motor significativo. Tampoco se registraron caídas durante la hospitalización. CONCLUSIONES: El uso de soluciones diluidas de bupivacaína y levobupivacaína en BCNF podría representar una buena opción para analgesia postoperatoria en ATR evitando la paresia significativa del cuádriceps. Estudios adicionales son necesarios para determinar la concentración y régimen de administración ideal para luego comparar con otras alternativas analgésicas preservantes del cuádriceps.

Clinical application of ultrasound-guided femoral nerve and popliteal sciatic nerve block in patients undergoing foot and ankle surgery / 中国基层医药

Objective To observe the application of ultrasound-guided femoral nerve block (FNB) and popliteal sciatic nerve block(PSNB) in patients undergoing foot and ankle surgery.Methods From August 2015 to August 2017,60 patients scheduled for foot and ankle surgery undergoing laryngeal mask airway (LMA) general anesthesia in the People's Hospital of Langfang were randomly divided into 3 groups by the random number table,with 20 cases in each group.Before transfer patients from bed to operating table,A group received dezocine 5 mg iv,B group received FNB combined with PSNB (distal to the sciatic nerve bifurcation),C group received FNB combined with PSNB(proximal to the sciatic nerve bifurcation).A total of 40 mL of 0.375％ ropivacaine were injected guided by ultrasound in B group and C group.The time of sufficient sensory block and awake,the dosage of remifentanil and propofol were recorded.Pain was assessed using visual analogue scale (VAS) pre-and post block.The incidence of sleepiness,postoperative nausea and vomiting (PONV),agitation,pain and adverse reaction were also recorded.Results The time of sufficient sensory block and awake,the dosage of remifentanil and propofol in A,B and C group:A group (not measured),(21.6 ± 1.6) min,(1183 ± 17) μg,(665.0 ± 6.7) mg;B group (25.5 ± 2.5) min,(15.3 ± 1.4) min,(635 ± 16) μg,(455.0 ±6.5)mg;C group (19.6 ±2.3)min,(14.9 ± 1.5)min,(598 ± 14) μg,(438.0±9.9) mg.The time of awake,the dosage of remifentanil and propofol in B group and C group were significantly lower than those in A group (F =44.07,52.41,62.45,all P ＜0.05).The time of sufficient sensory block in C group was lower than that in B group(t =15.69,P ＜ 0.05).The VAS scores at T2,T3 and T4 in A,B and C group:A group (4.5 ± 0.6) point,(8.4 ± 0.5) point,(6.1 ± 0.9) point;B group (2.6 ± 0.5) point,(3.9 ± 0.3) point,(2.4 ± 0.6) point;C group (2.5 ± 0.4) point,(2.3 ± 0.5) point,(1.1 ± 0.5) point.The VAS scores in B group or C group were significantly lower than those in A group (F =52.36,72.82,75.41,all P ＜ 0.05).The VAS scores at T3 and T4 in C group were significantly lower than those in B group (t =18.42,q =14.55,all P ＜ 0.05).The incidence rates of sleepiness,PONV,agitation and incision pain in A,B and C group:A group (25％,25％,15 ％,15 ％,50％);B group(0％,5％,0％,0％,10％);C group (0％,5％,0％,0％,0％).The number of patients who had adverse reactions in B or C group were significantly lower than those in A group (x2 =8.51,8.73,10.11,10.11,9.69,all P ＜0.05).The incidence rate of incision pain at sober in C group was lower than that in B group(x2 =10.89,P ＜0.05).Conclusion The ultrasound-guided FNB and PSNB (proximal to the sciatic nerve bifurcation) can obviously shorten the onset time,reduce the dosage of general anaesthetic.It has effective analgesia during transfer of patients from bed to operating table and sober.

Clinical observation of warm moxibustion therapy to improve quadriceps weakness after total knee arthroplasty / 中国针灸

OBJECTIVE@#To evaluate the clinical efficacy of warm moxibustion therapy in the recovery of quadriceps muscle strength in patients undergoing total knee arthroplasty (TKA) with analgesia of the femoral nerve block (FNB).@*METHODS@#A total of 174 patients with KOA were randomized into a warm moxibustion group and a rehabilitation group, 87 cases in each group. In the warm moxibustion group, warm moxibustion combined with conventional quadriceps strength training were used. In the rehabilitation group, conventional quadriceps strength training was given. The warm moxibustion was applied at Liangqiu (ST 34) and Zusanli (ST 36), the treatment was given twice a day, 7 days for one course, with a total of 2 courses.The quadriceps muscle strength of the two groups was recorded and compared at 24 h before FNB, 24, 48, 72 and 96 h after surgery, and the resting and exercise VAS pain scores were also recorded at the same time point. And the first time for standing up and the first straight raising time in the two groups were compared, and the occurrence of adverse reactions in the two groups were observed.@*RESULTS@#At 24, 48, 72 and 96 h after FNB, the quadriceps muscle strength in the warm moxibustion group was better than that in the rehabilitation group (<0.05, <0.01). At 72 h and 96 h after FNB, the resting and exercise VAS scores of the warm moxibustion group were lower than those of the rehabilitation group (both <0.001). The average first straight leg raising time in the warm moxibustion group was postoperative (31.03±10.78) h, and the time in the rehabilitation group was postoperative (47.23±15.78) h. The difference was statistically significant (<0.001). The average time of the first time for standing up in the warm moxibustion group was postoperative (25.76±7.00) h, and postoperative (33.12±11.18) h in the rehabilitation group. The difference was also statistically significant (<0.001). No adverse reactions occurred in both groups.@*CONCLUSION@#Warm moxibustion combined with conventional quadriceps strength training can improve the symptoms of quadriceps weakness in patients with femoral nerve block after total knee arthroplasty, and accelerate the recovery of joint function, which is superior to conventional quadriceps strength training.

Clinical application of ultrasound-guided femoral nerve and popliteal sciatic nerve block in patients undergoing foot and ankle surgery / 中国基层医药

Objective@#To observe the application of ultrasound-guided femoral nerve block(FNB) and popliteal sciatic nerve block(PSNB) in patients undergoing foot and ankle surgery.@*Methods@#From August 2015 to August 2017, 60 patients scheduled for foot and ankle surgery undergoing laryngeal mask airway (LMA) general anesthesia in the People′s Hospital of Langfang were randomly divided into 3 groups by the random number table, with 20 cases in each group.Before transfer patients from bed to operating table, A group received dezocine 5 mg iv, B group received FNB combined with PSNB(distal to the sciatic nerve bifurcation), C group received FNB combined with PSNB(proximal to the sciatic nerve bifurcation). A total of 40 mL of 0.375% ropivacaine were injected guided by ultrasound in B group and C group.The time of sufficient sensory block and awake, the dosage of remifentanil and propofol were recorded.Pain was assessed using visual analogue scale (VAS) pre- and post block.The incidence of sleepiness, postoperative nausea and vomiting (PONV), agitation, pain and adverse reaction were also recorded.@*Results@#The time of sufficient sensory block and awake, the dosage of remifentanil and propofol in A, B and C group: A group(not measured), (21.6±1.6)min, (1183±17)μg, (665.0±6.7)mg; B group (25.5±2.5)min, (15.3±1.4)min, (635±16)μg, (455.0±6.5)mg; C group (19.6±2.3)min, (14.9±1.5)min, (598±14)μg, (438.0±9.9)mg.The time of awake, the dosage of remifentanil and propofol in B group and C group were significantly lower than those in A group (F=44.07, 52.41, 62.45, all P<0.05). The time of sufficient sensory block in C group was lower than that in B group(t=15.69, P<0.05). The VAS scores at T2, T3 and T4 in A, B and C group: A group (4.5±0.6)point, (8.4±0.5)point, (6.1±0.9)point; B group (2.6±0.5)point, (3.9±0.3)point, (2.4±0.6)point; C group (2.5±0.4)point, (2.3±0.5)point, (1.1±0.5)point.The VAS scores in B group or C group were significantly lower than those in A group (F=52.36, 72.82, 75.41, all P<0.05). The VAS scores at T3 and T4 in C group were significantly lower than those in B group (t=18.42, q=14.55, all P<0.05). The incidence rates of sleepiness, PONV, agitation and incision pain in A, B and C group: A group (25%, 25%, 15%, 15%, 50%); B group(0%, 5%, 0%, 0%, 10%); C group(0%, 5%, 0%, 0%, 0%). The number of patients who had adverse reactions in B or C group were significantly lower than those in A group (χ2=8.51, 8.73, 10.11, 10.11, 9.69, all P<0.05). The incidence rate of incision pain at sober in C group was lower than that in B group(χ2=10.89, P<0.05).@*Conclusion@#The ultrasound-guided FNB and PSNB(proximal to the sciatic nerve bifurcation) can obviously shorten the onset time, reduce the dosage of general anaesthetic.It has effective analgesia during transfer of patients from bed to operating table and sober.

Spinal anesthesia with bupivacaine and fentanyl associated with femoral nerve block in postoperative analgesia in the reconstruction of the anterior cruciate ligament / Raquianestesia com bupivacaína e fentanil associada ao bloqueio do nervo femoral na analgesia pós-operatória na reconstrução do ligamento cruzado anterior

ABSTRACT BACKGROUND AND OBJECTIVES: To evaluate postoperative analgesia and the need for tramadol in patients undergoing reconstruction of the anterior cruciate ligament with spinal anesthesia, fentanyl and femoral nerve block. METHODS: 166 patients were divided into four groups (G). All patients received spinal anesthesia with 15mg of isobaric bupivacaine at 0.5%. In the G2 and G3 groups, 25µg of fentanyl was associated with bupivacaine and in groups G3 and G4 femoral nerve block was associated with 100mg of bupivacaine at 0.5%, without vasoconstrictor. Patients received timed dipyrone and ketoprofen and were instructed to request tramadol if the pain was ≥4 on the numerical scale. After 6, 12 and 24 hours of spinal anesthesia, the score was recorded on the numerical scale, the request of tramadol and adverse events. RESULTS: Mean pain scores at 6 and 24 hours were not different. In the 12-hour evaluation, there was a difference only in G4 in relation to G1 (p=0.01). Tramadol was requested by 46.7% in G1, 52.9% in G2, 18.6% in G3 and 36.4% in G4 (p=0.009), with a difference between G1 and G3 and also between G2 and G3. CONCLUSION: The association of spinal anesthesia and femoral nerve block in G4 provided lower pain scores in the evaluation at 12 hours after anesthesia. On the other hand, the highest indices were observed in G2, spinal anesthesia with fentanyl. Pain scores at 6 and 12 hours were similar. The highest consumption of analgesics occurred in those who reported more pain in G2.

RESUMO JUSTIFICATIVA E OBJETIVOS: Avaliar a analgesia pós-operatória e a necessidade de tramadol nos pacientes submetidos à operação de reconstrução do ligamento cruzado anterior com raquianestesia, fentanil e bloqueio do nervo femoral. MÉTODOS: Cento e sessenta e seis pacientes foram divididos em quatro grupos (G). Todos os pacientes receberam raquianestesia com 15mg de bupivacaína isobárica a 0,5%. Nos grupos G2 e G3 foi associado 25µg de fentanil à bupivacaína e nos grupos G3 e G4 foi associado bloqueio do nervo femoral com 100mg de bupivacaína a 0,5% sem vasoconstritor. Os pacientes receberam dipirona e cetoprofeno de horário e eram orientados a solicitar tramadol caso a dor estivesse ≥4 na escala numérica. Após 6, 12 e 24 horas da raquianestesia foi registrado o escore na escala numérica, a solicitação de tramadol e eventos adversos. RESULTADOS: Os escores médios de dor 6 e 24 horas não foram diferentes. Na avaliação 12 horas houve diferença apenas no G4 em relação ao G1 (p=0,01). O tramadol foi solicitado por 46,7% no G1, 52,9% no G2, 18,6% no G3 e 36,4% no G4 (p=0,009), com diferença entre G1 e G3 e também entre G2 e G3. CONCLUSÃO: A associação de raquianestesia e bloqueio do nervo femoral no G4 proporcionou menores escores de dor na avaliação 12 horas após a anestesia, por outro lado os índices mais elevados foram observados na raquianestesia com fentanil do G2. As avaliações de dor em 6 e 12 horas foram semelhantes. O maior consumo de analgésicos ocorreu naqueles que relataram mais dor no G2.

Acupuncture combined with femoral nerve block for postoperative analgesia after total knee arthroplasty and functional rehabilitation: a randomized controlled trial / 中国针灸

<p><b>OBJECTIVE</b>To observe the therapeutic effects on the postoperative analgesia after total knee arthroplasty (TKA) and functional rehabilitation with acupuncture at the distal points along the affected meridians and femoral nerve block.</p><p><b>METHODS</b>A total of 60 patients with knee prosthesis were collected and randomized into an observation group and a control group, 30 cases in each one. All of the patients received the femoral nerve block before operation. The analgesia pump was used for analgesia after operation and TKA postoperative rehabilitation was adopted. Additionally, in the observation group, acupuncture was applied to Taichong (LR 3), Kunlun (BL 60), Taixi (KI 3), Shenmai (BL 62), Sanyinjiao (SP 6) and Houxi (SI 3) unilaterally on the affected side, as well as Chize (LU 5), Quchi (LI 11) and Shousanli (LI 10) bilaterally. The needles were remained for 30 min, once a day, totally for 2 weeks. Separately, 4 h, 8 h, 12 h, 24 h and 48 h in resting after operation, as well as during the passive functional exercises 12 h, 24 h, 48 h, 7 d and 14 d after operation, the scores of visual analogue score (VAS) were recorded. HSS score, ROM before operation and 7 d and 14 d after operation, the analgesia satisfaction, the analgesic dose as well as the adverse reactions were recorded.</p><p><b>RESULTS</b>Regarding the VAS scores, 8 h, 12 h, 24 h and 48 h in resting after operation, the results in the observation group were lower than those in the control group (all <0.05). The VAS scores during the passive functional exercises 12 h, 24 h 48 h and 7 d after operation in the observation group were lower than those in the control group (all <0.05). The analgesia satisfaction in the observation group was higher than that in the control group (<0.05). 72 h, 7 d and 14 d after operation, HSS scores in the observation group were better than those in the control group (all <0.05) and the effects of ROM in the observation group were better than those in the control group (both <0.05). Regarding the safety, the adverse reaction rate in the observation group was lower than that in the control group (<0.05).</p><p><b>CONCLUSION</b>The combined treatment with acupuncture along the meridians and femoral nerve block achieves the remarkably analgesia effects after TKA and definite effects of the joint function recovery. This combined therapy is favorable in safety and adverse reactions.</p>

A Comparison of the Results from Femoral Nerve Block Using Different Concentration of Ropivacaine after Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: Peripheral nerve block is one of the many options available to reduce pain after total knee arthroplasty. Among the various kinds of peripheral nerve block procedure, femoral nerve block (FNB) using ropivacaine is a very effective method for reducing pain. However, it has been known to cause weakness in the quadriceps femoris, resulting in an increased risk of fall during ambulation after surgery. The purpose of this study was to compare the effectiveness of FNB on pain and muscle strength with different concentrations of ropivacaine. MATERIALS AND METHODS: Our study was performed on 120 patients with knee osteoarthritis who had undergone total knee arthroplasty between January 2016 and December 2016. Patients were divided to 3 groups depending on the concentration of ropivacaine: Group 1 received 0.125% ropivacaine 6 ml FNB; group 2 received 0.2% ropivacaine 6 ml FNB; group 3 received normal saline 6 ml FNB. FNB with 1% lidocaine 10 ml and 0.75% ropivacaine 10 ml was performed to all groups at 3 hours after surgery. From the day after surgery, each group of patients were injected 4 times with FNB on their own designated concentration of ropivacaine with an interval of 6 hours. The severity of pain was estimated by visual analogue scale (VAS) and the strength of quadriceps femoris was measured using medical research council (MRC) grade and knee extension angle. RESULTS: VAS score in group 3 was significantly higher compared to other groups; MRC grade in group 2 was significantly lower than in other grades, and knee extension angle in group 2 was significantly lower than in other groups at 6 pm on the day of and at 6 am on the day after surgery. VAS score, MRC grade, and extension angle of all groups showed no significantly difference at other times. CONCLUSION: FNB with 0.125% ropivacaine after total knee arthroplasty shows effective reduction of pain without inducing quadriceps femoris weakness.

Bloqueo del nervio femoral con estimulador de nervio periférico en la artroscopia de rodilla / Femoral nerve block with peripheral nerve stimulator in knee arthroscopy

Introducción: el bloqueo del nervio femoral es una de las técnicas básicas del bloqueo nervioso. Objetivo: describir los resultados del bloqueo del nervio femoral con estimulador de nervio periférico en pacientes intervenidos de artroscopia de rodilla. Método: estudio observacional, descriptivo, prospectivo de corte longitudinal. La muestra estuvo integrada por 84 pacientes intervenidos de artroscopia de rodilla en los cuales se utilizó el bloqueo del nervio femoral como técnica anestésica. Se incluyeron pacientes mayores de 18 años, con estado físico I-III según la Sociedad Americana de Anestesiología (ASA), sin alergia conocida a los anestésicos locales y sin contraindicaciones para las técnicas regionales; se excluyeron del estudio aquellos pacientes con intervención quirúrgica ilioinguinal previa, con tumoraciones en región inguinal o neuropatía femoral. Resultados: la calidad del bloqueo fue buena en 90,5 por ciento, de los pacientes, regular en 7,1 por ciento y mala en el 2,4 por ciento. La media del tiempo de analgesia al movimiento fue de 15,17 h (DE 10,52), con un mínimo de 4,17 y un máximo de 28,40 h. Las complicaciones fueron escasas (9,52 por ciento). La más frecuente resultó la parestesia y el bloqueo insatisfactorio en 4,8 y 2,4 por ciento respectivamente. El grado de pacientes satisfechos fue el 95,2 por ciento del total. Conclusiones: el tiempo de analgesia en más de la mitad de los pacientes fue mayor de 12 h y la intensidad del dolor en el rango de dolor leve-moderado, tanto en reposo como al realizar algún movimiento. Las complicaciones fueron escasas, la más frecuente fue la parestesia. La técnica se asocia con elevados niveles de satisfacción por parte de los pacientes(AU)

Introduction: The femoral nerve block is one of the basic nerve block techniques. Objective: To describe the results of femoral nerve block with peripheral nerve stimulator in patients undergoing knee arthroscopy. Method: Observational, descriptive, prospective and longitudinal study. The sample consisted of 84 patients undergoing knee arthroscopy, in whom femoral nerve block was used as an anesthetic technique. Patients older than 18 years were included, with physical status I-III according to the American Society of Anesthesiology (ASA), without known allergy to local anesthetics and without contraindications for regional techniques; patients with previous ilioinguinal surgery, and with tumors in the inguinal region or femoral neuropathy, were excluded from the study. Results: The block quality was good in 90.5 percent of the patients, regular in 7.1 percent, and poor in 2.4 percent. The average time of analgesia to movement was 15.17 hours (SD 10.52), with a minimum of 4.17 and a maximum of 28.40 hours. Complications were minimal (9.52 percent). The most frequent was paresthesia and the unsatisfactory block, in 4.8 and 2.4 percent, respectively. The degree of satisfied patients was 95.2 percent of the total. Conclusions: The analgesic time in more than half of the patients was greater than 12 hours, while the pain intensity was in the range of mild to moderate, both at rest and when performing some movement. Complications were minimal, the most frequent was paresthesia. The technique is associated with high levels of satisfaction as expressed by the patients(AU)

Anesthesia for lower extremity vascular bypass with peripheral nerve block / Anestesia para bypass vascular em membro inferior com bloqueio de nervos periféricos

Abstract Vascular bypass is a surgical procedure widely used to treat peripheral vascular disease. The intraoperative anesthetic technique and the most appropriate postoperative analgesia for these high-risk patients remain controversial. We present the case of a patient undergoing femoropopliteal-distal bypass in our service, presenting with relevant comorbidities to the choice of anesthetic technique. This patient had several determining factors of difficult airway, especially thoracic kyphoscoliosis, which prevented him from being properly positioned for airway management, and chronic lung disease. This patient was also taken antiplatelet drugs, which is a contraindication for neuraxial block. So, we chose the anesthetic technique of peripheral nerve block, specifically the blockade of femoral and sciatic nerves.

Resumo A cirurgia para bypass vascular é um procedimento amplamente usado para o tratamento da insuficiência vascular periférica. A técnica anestésica para o intraoperatório e para analgesia pós-operatória mais apropriada para esses pacientes de alto risco ainda permanece controversa. Apresentaremos o caso de um paciente submetido a bypass femoropoplíteo distal no nosso serviço, que apresentava comorbidades relevantes para a escolha da técnica anestésica. Esse paciente apresentava fatores determinantes de via aérea difícil, principalmente cifoescoliose da coluna torácica, que o impedia de ser posicionado adequadamente para o manejo da via aérea, além de ser portador de patologia pulmonar crônica. Também fazia uso de antiplaquetários que contraindicavam o bloqueio de neuroeixo. Por isso, optou-se como técnica anestésica pelo bloqueio de nervos periféricos, especificamente o bloqueio dos nervos femoral e isquiático.

Femoral nerve block versus intravenous fentanyl in adult patients with hip fractures - a systematic review / Bloqueio do nervo femoral versus fentanil por via venosa em pacientes adultos com fraturas de quadril - revisão sistemática

Abstract Background: Hip fractures configure an important public health issue and are associated with high mortality taxes and lose of functionality. Hip fractures refer to a fracture occurring between the edge of the femoral head and 5 cm below the lesser trochanter. They are common in orthopedic emergencies. The number of proximal femoral fractures is likely to increase as the population ages. The average cost of care during the initial hospitalization for hip fracture can be estimated about US$ 7,000 per patient. Femoral fractures are painful and need immediate adequate analgesia. Treating pain femoral fractures is difficult because there are limited numbers of analgesics available, many of which have side effects that can limit their use. Opiates are the most used drugs, but they can bring some complications. In this context, femoral nerve blocks can be a safe alternative. It is a specific regional anesthetic technique used by doctors in emergency medicine to provide anesthesia and analgesia of the affected leg. Objective: To compare the analgesic efficacy of intravenous fentanyl versus femoral nerve block before positioning to perform spinal anesthesia in patients with femoral fractures assessed by Pain Scales. Methods: A systematic review of scientific literature was conducted. Studies described as randomized controlled trials comparing femoral nerve block and traditional fentanyl are included. Two reviewers (MR and FH) independently assessed potentially eligible trials for inclusion. The methodology assessment was based on the tool developed by the Cochrane Collaboration for assessment of bias for randomized controlled trials. The Cochrane Library, Pubmed, Medline and Lilacs were searched for all articles published, without restriction of language or time. Results: Two studies were included in this review. Nerve blockade seemed to be more effective than intravenous fentanyl for preventing pain in patients suffering from a femoral fracture. It also reduced the use of additional analgesia and made lower the risk for systemic complications. Femoral nerve block reduced the time to perform spinal anesthesia to the patient who will be subjected to surgery and facilitate the sitting position for this. Conclusion: The use of femoral nerve block can reduce the level of pain and the need for additional analgesia. There are less adverse systemic events associated with this and the procedure itself does not offer greater risks. More studies are required for further conclusions.

Resumo Justificativa: As fraturas de quadril são uma questão importante de saúde pública e estão associadas a altas taxas de mortalidade e perda de funcionalidade. As fraturas de quadril referem-se a uma fratura que ocorre entre a borda da cabeça femoral e 5cm abaixo do trocanter menor e são comuns em emergências ortopédicas. O número de fraturas do fêmur proximal provavelmente aumentará à medida que a população envelhece. O custo médio da assistência médica durante a hospitalização inicial para fratura de quadril pode ser estimado em US$ 7.000 por paciente. As fraturas do fêmur são dolorosas e requerem analgesia adequada imediata. O tratamento da dor causada por fraturas de fêmur é difícil porque há um número limitado de analgésicos disponíveis, muitos dos quais têm efeitos colaterais que podem limitar o seu uso. Os opioides são os fármacos mais usados, mas podem trazer algumas complicações. Nesse contexto, os bloqueios do nervo femoral podem ser uma opção segura. É uma técnica de anestesia regional específica usada em medicina de emergência para proporcionar anestesia e analgesia do membro afetado. Objetivo: Comparar a eficácia analgésica de fentanil versus bloqueio do nervo femoral antes do posicionamento para fazer raquianestesia em pacientes com fratura de fêmur avaliados com escalas de dor. Métodos: Revisão sistemática da literatura científica. Estudos descritos como ensaios clínicos randomizados que comparam bloqueio do nervo femoral e fentanil tradicional foram incluídos. Dois autores da revisão (MR e FH) avaliaram de forma independente os estudos potencialmente elegíveis para inclusão. A metodologia da avaliação baseou-se na ferramenta desenvolvida pela Colaboração Cochrane para avaliação de viés dos ensaios clínicos randomizados. As bases de dados Biblioteca Cochrane, PubMed, Medline e Lilacs foram consultadas para todos os artigos publicados, sem restrições de língua ou de tempo. Resultados: Dois estudos foram incluídos nesta revisão. O bloqueio do nervo pareceu ser mais eficaz do que fentanil por via intravenosa para a prevenção da dor em pacientes com fratura femoral. Também reduziu o uso de analgesia adicional e diminuiu o risco de complicações sistêmicas. O bloqueio femoral reduziu o tempo de administração da raquianestesia ao paciente a ser submetido à cirurgia e facilitou a posição sentada para esse fim. Conclusão: O uso de bloqueio do nervo femoral pode reduzir o nível de dor e a necessidade de analgesia adicional. Há menos eventos adversos sistêmicos associados a esse procedimento, que não oferece maiores riscos. Mais estudos são necessários para conclusões adicionais.

Analgesic Effect of Continuous Femoral Nerve Block Combined with Parecoxib on Patients Undergoing Total Knee Replacement Surgery / 现代生物医学进展

Objective:To investigate the postoperative analgesia effect of continuous femoral nerve block (CFNB) combined with parecoxib on the patients with Total knee arthroplasty (TKA).Methods:A total of 100 patients,who underwent unilateral TKA in Affiliated Hospital of Guizhou Medical University from January 2015 to December 2016,were selected and randomly divided into study group (n=50) and control group (n=50).After TKA,the patients of two groups were received CFNB,CFNB combined with parecoxib analgesia respectively,analgesic time was 2 days.The visual analogue pain scores (VAS) of the patients of two groups at rest and during exercise and the incidence of postoperative adverse reactions were observed at 6h,12 h,24 h,48 h after operation.The Hospital Special Surgery knee score (HSS) was used to evaluate the joint function of patients in the two groups 1 d before operation and 1 d,2 d,3 d after operation.Results:Resting state VAS and motion state VAS in the study group were significantly lower than those in the control group 6 h,12 h,24 h,and 48 h after operation (P＜0.05).There were no significant differences in the incidence of nausea / vomiting,respiratory depression,catheter related problems,and urinary retention between the two groups (P＞0.05).There was no significant difference in HSS score between the two groups 1 d before operation(P＞0.05).The HSS scores of the patients in the two groups 1 d,2 d,3 d after operation were significantly higher than those 1d before operation,and the HSS scores of the patients in the study group were significantly higher than those in the control group (P＜0.05).Conclusion:CFNB combined with parecoxib has the advantages of good analgesic effect and safety for postoperative analgesia of the patients undergoing TKA,which is good for the patients' early knee joint function exercise and is worthy of clinical promotion.

Effect of levobupivacaine on magnesium sulfate combined with ultrasound-guided femoral nerve block on postoperative analgesia in anterior cruciate ligament reconstruction / 临床麻醉学杂志

Objective To investigate the effect of the compound administration of levobupiva-caine and magnesium sulfate in ultrasonography-guided femoral block on postoperative analgesia of anterior cruciate ligament reconstruction.Methods A total of 107 patients,66 males and 41 females, aged 25-60 years,ASA physical status Ⅰ or Ⅱ,undergoing arthroscopic anterior cruciate ligament (ACL)reconstruction,were randomly divided into magnesium sulfate group (n = 56 )and control group (n = 51 ).Both groups were treated with ultrasound-guided ipsilateral femoral nerve block before anesthesia induction.The patients in the magnesium sulfate group were treated with 0.25%levobupivacaine and 2% magnesium sulfate mixture 20 ml,and the control group was treated with 0.25% levobupivacaine 20 ml.The blocking of sensation and movement of femoral nerve was recor-ded.The VAS scores of resting and exercise were recorded at 4,6,12,24 and 48 h after operation. The additional analgesics,tramadol dosage,satisfaction score at postoperative 48 h,incidence of nau-sea and vomiting and other adverse reactions at 48 h after surgery were recorded.Results At postop-erative 12 h,VAS score was significantly lower in the magnesium sulfate group than that in the con-trol group (P <0.05).There were 5 cases (8.9%)needing additional analgesics in the magnesium sulfate group,significantly lower than 10 cases (19.6%)in the control group (P <0.05).The tram-adol dosage of magnesium sulfate group was significantly lower than that in the control group (P <0.05).The duration and onset time of sensation and movement block and Likert satisfaction score in the magnesium sulfate group were significantly superior to that of control group (P <0.05).The inci-dence of adverse reactions between the two groups were not statistically different.Conclusion The combined applications of levobupivacaine and magnesium sulfate in ultrasound-guided ipsilateral femo-ral nerve block could shorten the onset time and prolong the duration of blocking,improve the post-operative analgesic effect and patients' satisfaction, reduce the dosage of analgesic drugs. Additionally,it dose not increase the incidence of adverse reactions.

Comparison of the Effect of Continuous Femoral Nerve Block and Adductor Canal Block after Primary Total Knee Arthroplasty

BACKGROUND: This study aimed to compare the effects of femoral nerve block and adductor canal block on postoperative pain, quadriceps strength, and walking ability after primary total knee arthroplasty. METHODS: Between November 2014 and February 2015, 60 patients underwent primary total knee arthroplasty. Thirty patients received femoral nerve block and the other 30 received adductor canal block for postoperative pain control. Before spinal anesthesia, the patients received nerve block via a catheter (20 mL 0.75% ropivacaine was administered initially, followed by intermittent bolus injection of 10 mL 0.2% ropivacaine every 6 hours for 3 days). The catheters were maintained in the exact location of nerve block in 24 patients in the femoral nerve block group and in 19 patients in the adductor canal block group. Data collection was carried out from these 43 patients. To evaluate postoperative pain control, the numerical rating scale scores at rest and 45° flexion of the knee were recorded. To evaluate quadriceps strength, manual muscle testing was performed. Walking ability was assessed using the Timed Up and Go test. We also evaluated analgesic consumption and complications of peripheral nerve block. RESULTS: No significant intergroup difference was observed in the numerical rating scale scores at rest and 45° flexion of the knee on postoperative days 1, 2, 3, and 7. The adductor canal block group had significantly greater quadriceps strength than did the femoral nerve block group, as assessed by manual muscle testing on postoperative days 1, 2, and 3. The 2 groups showed no difference in walking ability on postoperative day 1, but on postoperative days 2, 3, walking ability was significantly better in the adductor canal block group than in the femoral nerve block group. No significant intergroup difference was observed in analgesic consumption. CONCLUSIONS: The groups showed no difference in postoperative pain control. Adductor canal block was superior to femoral nerve block in preserving quadriceps strength and walking ability. However, adductor canal block was inferior to femoral nerve block in maintaining the exact location of the catheter.

Anestesia regional periférica para revascularización arterial de miembros inferiores. Revisión bibliográfica y casos clínicos / Peripheral regional anesthesia for arterial revascularization of lower limbs. Bibliographical review and clinical cases

Introducción: La tendencia actual es diferir la cirugía de revascularización de miembros inferiores hasta etapas avanzadas, lo que explica que sean pacientes de mayor complejidad con alta morbimortalidad cardíaca y respiratoria. Los mayores avances para reducirlas, se han desarrollado en la preparación de los pacientes y en las técnicas quirúrgicas. La elección de la técnica anestésica no ha sido considerada un factor determinante. Los bloqueos regionales presentan potenciales ventajas, como mayor estabilidad hemodinámica y respiratoria. Objetivo: Realizar una revisión bibliográfica y presentación de casos clínicos sobre la utilidad de los bloqueos periféricos para anestesia en la cirugía de revascularización de miembros inferiores. Material y métodos: La búsqueda se realizó a través de la base de datos Medline, LILACS y SciELO. Se incluyeron estudios donde los bloqueos periféricos se utilizaron para anestesia. Se describen dos casos clínicos. Resultados: Se seleccionaron 4 artículos originales, 3 de ellos eran estudios descriptivos de la técnica y el cuarto una comparación con anestesia general inhalatoria. 2más correspondieron a casos clínicos. Conclusiones: No existe evidencia suficiente que permita concluir que reducen la mortalidad o la morbilidad cuando se la compara con las demás técnicas anestésicas. Esto puede ser debido al diseño metodológico de los estudios, a la no utilización de la ecografía como guía y la no sistematización de los bloqueos. El análisis de los casos clínicos sugiere que en situaciones específicas como pacientes de alto riesgo cardíaco y respiratorio, bajo tratamiento con anticoagulantes y antiagregantes estos presentan ventajas sobre las otras técnicas.

Background: The current trend is to defer revascularization surgery from lower limbs to advanced stages, which explains why they are more complex patients with high cardiac and respiratory mortality. The choice of anesthetic technique remains controversial. Regional blockades have potential advantages, such as hemodynamic and respiratory stability. Our primary objective was a bibliographic review to assess the peripheral blockages for anesthesia in lower limb revascularization surgery. Our secondary objective was report two clinical cases. Material and methods: The search was performed through the Medline, LILACS and SciELO database. We included studies where peripheral blocks were used for anesthesia. Two clinical cases are described. Results: Four original articles were selected, 3 of which were descriptive studies of the technique and the fourth a comparison with general inhalation anesthesia. 2 more corresponded to clinical cases. Conclusions: There is insufficient evidence to conclude that peripheral nerve block reduce mortality or morbidity when compared with other anesthetic techniques. This may be due to the methodological design of the studies, to the non-use of echocardiography as a guide and the non-systematization of the blocks. The analysis of the clinical cases suggests that this technique is a good option in specific situations as patients with high cardiac and respiratory risk, under treatment with anticoagulants and antiplatelets drugs.