COMPARATIVE STUDY
JOURNAL ARTICLE
META-ANALYSIS
RESEARCH SUPPORT, NON-U.S. GOV'T
REVIEW
Add like
Add dislike
Add to saved papers

Is sciatic nerve block advantageous when combined with femoral nerve block for postoperative analgesia following total knee arthroplasty? a meta-analysis.

BACKGROUND: Total knee arthroplasty (TKA) is associated with moderate-to-severe postoperative pain despite the use of femoral nerve block (FNB). The analgesic benefits of adding sciatic nerve block (SNB) to FNB following TKA are unclear. The aim of this meta-analysis was to quantify the analgesic effects of adding SNB to FNB following TKA.

METHODS: We searched the US National Library of Medicine (MEDLINE), Excerpta Medica (Embase), and Cochrane Central Controlled Trials Register databases in March 2015 for randomized and quasi-randomized controlled trials (RCTs) that evaluated the analgesic advantages of adding SNB to FNB compared to FNB alone after TKA. The designated primary outcome was intravenous morphine consumption during the 24-hr postoperative interval. The severity of pain was evaluated at rest and with movement two, four, eight, 12, 24, 36, and 48 hr postoperatively. Morphine consumption during the postoperative 24-48 hr interval, time to first analgesic request, opioid-related side effects, block-related complications, patient satisfaction, functional recovery, and time to hospital discharge were also evaluated. Trials were stratified based on whether a single-shot SNB (SSNB) or continuous SNB (CSNB) was used. Data were combined using random effects modelling.

RESULTS: Eight RCTs, including 379 patients, were analyzed. Five trials examined SSNB, and three assessed CSNB. Together, SSNB and CSNB reduced the 0-24 hr weighted mean difference [95% confidence interval] of morphine consumption by 10.6 [-20.9 to -0.3] mg (P = 0.042; I(2) = 97%) and 20.5 [-28.6 to -12.4] mg (P < 0.001, I(2) = 86%), respectively. SSNB reduced pain at rest and during movement up to 8 hr postoperatively (P = 0.023 and P < 0.001, respectively), whereas CSNB reduced pain at rest up to 36 hr (P = 0.004) and pain with movement up to 48 hr (P = 0.031). CSNB also decreased the odds of postoperative nausea and vomiting by 91% (P = 0.011).

CONCLUSION: The available evidence supporting the analgesic benefits of adding SNB to FNB following TKA is marked by significant heterogeneity. With this challenge in mind, our meta-analysis suggests that SNB can significantly reduce postoperative opioid consumption and diminish knee pain following TKA compared to no SNB in the setting of FNB.

Full text links

We have located links that may give you full text access.
Can't access the paper?
Try logging in through your university/institutional subscription. For a smoother one-click institutional access experience, please use our mobile app.

For the best experience, use the Read mobile app

Mobile app image

Get seemless 1-tap access through your institution/university

For the best experience, use the Read mobile app

All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

By using this service, you agree to our terms of use and privacy policy.

Your Privacy Choices Toggle icon

You can now claim free CME credits for this literature searchClaim now

Get seemless 1-tap access through your institution/university

For the best experience, use the Read mobile app