Evaluation of the effects of femoral, sciatic or femoral, sciatic, obturator nerve blocks on postoperative pain and healing process in patients undergoing knee arthroplasty

Introduction In our study, we aimed to evaluate the effects of femoral, sciatic or femoral, sciatic, obturator nerve blocks on postoperative pain and healing process in patients who underwent total knee arthroplasty (TKA). Peripheral nerve blocks in TKA operations are techniques frequently used in clinical practice for postoperative pain control. Studies have shown positive effects of peripheral blocks in TKA cases on postoperative pain control. Consequently, the consumption of narcotic analgesics has decreased and the incidence of nausea and vomiting in the postoperative period has decreased. This study was conducted to examine the effects of femoral, sciatic and obturator nerve blocks, which are routinely applied in total knee arthroplasties in our clinic, on postoperative pain and consequently narcotic analgesic consumption, effects on nausea, vomiting and discharge times. Material and Methods In our study, 50 patients with ASA score I-III between the ages of 40-80 who underwent elective TKA after approval of the ethics committee were included. The patients were randomly divided into two groups. Group FS; patients undergoing femoral and sciatic nerve block, group FSO; includes patients who will undergo femoral, sciatic and obturator nerve block. Nerve blocks were performed preoperatively under the guidance of ultrasonography and nerve stimulator. Patients who underwent unilateral TKA with spinal anesthesia were taken to the recovery room during the postoperative period. At the postoperative 0th, 2th, 4th, 8th, 12th and 24th hours, the resting VAS scores and nausea and vomiting symptoms of the patients were recorded. In addition, the dynamic VAS score of the patients at the 8th, 12th and 24th hours, additional analgesia initiation hours, 24-hour total analgesic use, discharge time and patient satisfaction were evaluated. Results The 4th hour resting VAS score of patients with FS nerve block was significantly higher than the 4 hour resting VAS score of patients with FSO nerve block. In addition, the 8th hour resting VAS score of patients with FS nerve block was significantly higher than the 8th hour resting VAS score of patients with FSO nerve block. In patients with FS nerve block, the time to start additional analgesic need was significantly earlier than patients with FSO nerve block. Conclusion It has been shown that the obturator nerve block, which we added to the femoral and sciatic nerve block applied for postoperative pain in TKA operations, positively contributed to the postoperative VAS score and additional analgesic onset time. Keywords: Femoral, sciatic, obturator nerve block, total knee arthroplasty, visual analog scale, analgesic consumption, patient satisfaction