Comparative study between epidural anesthesia and peripheralnerve blockade in major knee surgery

Objectives The efficacy of peripheral nerve block (PNB) in the form of combined femoral, sciatic,and obturator nerve blocks was compared with epidural anesthesia (EA) in patients undergoing major knee surgery. Patients and methods The study included 40 patients of American Society of Anesthesiologists physical status I and II (age range 20–60 years) undergoing major knee surgery. The patients were randomly divided into two groups. EA was performed on patients in the EA group(n = 20), and the femoral, sciatic, and obturator nerves were blocked in the patients belonging to the PNB group (n = 20). For each patient, success in providing adequate anesthesia, onset of sensory and motor block, hemodynamic changes, time to first analgesic request, and patient and surgeon satisfaction with the anesthetic technique were recorded. Results Two patients in the EA group and four patients in the PNB group required general anesthesia because of failed blocks. There were no significant differences between the two groups with regard to the success of providing adequate anesthesia. The onset of sensory motor block and the time to first analgesic request were significantly more prolonged in the PNB group than in the EA group. The incidence of hypotension was significantly higher in the EA group. Patient satisfaction was higher in the PNB group because of longer duration of postoperative analgesia, whereas surgeon satisfaction was higher in the EA group because of shorter time to achieve the block. Conclusion Femoral, sciatic, and obturator nerve blocks provide effective unilateral anesthesia and may offer a beneficial alternative to EA in patients undergoing total knee surgery.