Continuous psoas and sciatic block after knee arthroplasty: good effects compared to epidural analgesia or i.v. opioid analgesia: A prospective study of 63 patients

Abstract

Introduction For endoprosthetic knee surgery, intensive postoperative pain therapy is necessary. We therefore evaluated whether the combination of continuous psoas compartment and sciatic analgesia (PSC) is as effective as epidural analgesia (EPI) and whether it provides better analgesia than patient-controlled intravenous analgesia with piritramide (PCA).

Methods We studied 63 patients who underwent total knee arthroplasty (TKA). The PSC group received a combination of continuous psoas and sciatic nerve block, the EPI group an epidural analgesia, and the PCA group an intravenous patient-controlled piritramide pump. Pain scores, satisfaction, flexion and side effects were recorded.

Results Pain scores (0–10) were higher in the PCA group (on movement, day 1/day 2: 7.0/6.5) than in the EPI group (5.0/5.0) and the PSC group (4.0/3.5). Postoperative opioid consumption over 48 h was higher in the PCA group (51 mg) than in the EPI group (0 mg) and the PSC group (0 mg). There were no differences in functional recovery. Pruritus occurred more frequently in the PCA and EPI groups than in the PSC group. Patients receiving a PSC and EPI were more satisfied than those treated with PCA.

Interpretation Analgesia with PSC catheters or EPI catheter is superior to PCA regarding pain levels, analgesic requirements, and patient satisfaction. There was no difference in functional outcome between the 3 groups.

Contributions of authors

CR: participated in the development of the concept of the study, collected data, and wrote the manuscript. GM and CP were involved in the concept of the study, performed the knee arthroplasties, supervised physiotherapists, and revised the manuscript. JB: perfomed the regional anesthesias, co-developed the concept of the study, and revised the manuscript. KP and AAW: participated in the developement of the study, examined patients, collected data, and revised the manuscript. LMD and AM: asked for patient consent, collected data, and revised the manuscript. TV: designed the study, analyzed the data, and wrote the manuscript.