Continuous psoas sciatic blockade for total knee arthroplasty

BACKGROUND: Psoas sciatic block (Pso/Sci) is a modern anesthetic technique for lower extremities surgery. The use of this technique can avoid the adverse effects of the general anesthesia or the central neuroaxial blockade, especially in patients with multiple comorbidities. PURPOSE: The purpose of this study is to compare the efficacy of combined Pso/sci as a sole anesthetic technique with conventional combined spinal epidural (CSE) anesthesia for patients undergoing total knee arthroplasty. METHODS: Eighty patients scheduled for total knee replacement were included in the study. Patients were divided into two equal groups: Pso/sci group received ultrasound guided with the use of nerve locator continuous Pso/sci and the second group (CSE) received CSE anesthesia. Onset of sensory and motor block time, hemodynamic changes, contralateral spread, first-time need for analgesia, incidence of complications, and patient and surgeon satisfactions were recorded. RESULTS: The block time was significantly higher in the (Pso/Sci) group. Two patients in (Pso/Sci) had contralateral spread. Sensory and motor block onsets were delayed significantly in (Pso/Sci). Hemodynamic changes occurred in the CSE; however, it was insignificant compared to Pso/sci group. The first analgesic request was significantly later in (Pso/Sci) compared to the CSE group. There were no differences found in both groups as regard complications, early mobilization, and patients and surgeons satisfaction. CONCLUSIONS: Psoas sciatic block is an alternative safe and successful anesthetic technique, which can provide an adequate anesthesia for total knee surgery with less hemodynamic changes.