Adding a Low-concentration Sciatic Nerve Block to Total Knee Arthroplasty in Patients Susceptible to the Adverse Effects of Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

A Randomized Controlled Trial

Busara Sirivanasandha; Kulwadee Sutthivaiyakit; Thippatai Kerdchan; Suppachai Poolsuppasit; Suwimon Tangwiwat; Pathom Halilamien

Disclosures

BMC Anesthesiol. 2021;21(282)

Conclusions

For patients susceptible to the adverse effects of NSAIDs, adding a low concentration of SNB combined with dexamethasone is an effective adjunctive technique to ACB and PIA for acute postoperative pain control in TKA. It offers benefits in early postoperative pain control (especially pain on movement) without a significant motor blockade.

1 2 3 4 5 6

Next Section

Abbreviations
SNB: Sciatic nerve block; TKA: Total knee arthroplasty; NSAID: Non-steroidal anti-inflammatory drug; ACB: Adductor canal block; PIA: Periarticular infiltration analgesia; SD: Standard deviation; IQR: Interquartile range; BMI: Body mass index; CKD: Chronic kidney disease; Cr: Creatinine; DM: Diabetes mellitus; eGFR: Glomerular filtration rate; HT: Hypertension; IHD: Ischemic heart disease; NRS: Numeric rating scale; COX-2 inhibitor: Cyclooxygenase-2 inhibitor; IPACK: Infiltration of the local anesthetic between the popliteal artery and capsule of the knee; LAST: Local anesthetic systemic toxicity.

Acknowledgements
The authors are indebted to Miss Julaporn Pooliam for assistance with the methodology, Miss Chusana Rungjindamai for her invaluable support with administrative work, and to Mr. David Park for thoroughly proofreading the manuscript.

Funding
Not applicable.

Availability of data and materials
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Declarations
Ethics approval and consent to participate
This study was approved by Siriraj Institutional Review Board (SIRB) COA no. Si123/2018. Project approval was obtained prior to the initiation of the study. After being briefed on the research objectives and the experimental methods, each eligible patient signed a consent document on their respective day of admission.

Consent for publication
Not applicable.

Table 1. Demographic data
	Control (n = 25)	SNB (n = 25)	P-value
Female (n, %)	18 (72%)	19 (76%)	0.747
Age (mean ± SD)	73.88 ± 7.76	73.72 ± 6.94	0.939
BMI (mean ± SD)	28.51 ± 5.43	26.28 ± 3.00	0.080
Underlying disease
CKD (n, %)	17 (68%)	16 (64%)	0.765
DM (n, %)	11 (44%)	13 (52%)	0.571
HT (n, %)	21 (84%)	24 (96%)	0.349
IHD (n, %)	7 (28%)	7 (28%)	1.000
Stroke (n, %)	8 (32%)	6 (24%)	0.529
eGFR (mean ± SD)	48.90 ± 21.91	52.94 ± 22.13	0.520
Preoperative pain (median [IQR])	3 (2–5)	4 (3–4.5)	0.835
Operative time (min) (mean ± SD)	90 ± 21	95 ± 31	0.462
Tourniquet time (min) (mean ± SD)	85 ± 17	84 ± 24	0.850

BMI body mass index, CKD chronic kidney disease, Control control group, Cr creatinine, DM diabetes mellitus, eGFR glomerular filtration rate, HT hypertension, IHD ischemic heart disease, SNB popliteal-sciatic nerve block group

Table 2. Postoperative results
	Control (n = 25)		SNB (n = 25)		P-value
	Median	(25–75)	Median	(25–75)	P-value
Pain at rest (NRS; 0–10)
6 h	1	0–4.5	0	0–0	0.012*
12 h	3	0–5	0	0–3	0.021*
18 h	3	2–5	1	0–3	0.010*
24 h	3	1–5	2	1–3.5	0.187
Pain on movement (NRS; 0–10)
6 h	3	0–5.5	0	0–1.5	0.019*
12 h	5	2.5–6.5	2	0–4	0.005*
18 h	7	4–9	3	2–5	0.001*
24 h	5	4.5–8	5	2.5–7	0.169
Anterior-knee pain (NRS; 0–10)
6 h	2	0–4.5	0	0–0	0.002*
12 h	2	0–4	0	0–3	0.032*
18 h	3	0.5–5	1	0–3	0.015*
24 h	3	1.5–5	2	0–2.5	0.028*
Posterior-knee pain (NRS; 0–10)
6 h	0	0–0	0	0–0	0.370
12 h	0	0–2.5	0	0–0	0.038*
18 h	0	0–2	0	0–0	0.129
24 h	0	0–2	0	0–1	0.666
Motor weakness (n, %)
6 h	4	16%	6	24%	0.615
12 h	2	8%	2	8%	1.000
18 h	1	4%	1	4%	1.000
24 h	1	4%	0	0%	1.000
Pain on physiotherapy (NRS; 0–10)
24 h	6	5–8	5	3–7	0.083
48 h	3.5	2.3–6.8	3.5	2–5	0.478
Patient satisfaction score (0–10)	10	8–10	10	10–10	0.085
Total morphine in 24 h (mg)	4	2–8	2	0–2.5	0.005*

(25–75) interquartile range 25, 75, Control control group, NRS numeric rating scale, SNB popliteal-sciatic nerve block group, * P-value < 0.05