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Postoperative Analgesia and Functional Recovery After Total-Knee Replacement: Comparison of a Continuous Posterior Lumbar Plexus (Psoas Compartment) Block, a Continuous Femoral Nerve Block, and the Combination of a Continuous Femoral and Sciatic Nerve Block
  1. Astrid M. Morin, M.D.,
  2. Caroline D. Kratz, M.D.,
  3. Leopold H.J. Eberhart, M.D.,
  4. Gerhard Dinges, M.D.,
  5. Elke Heider, M.S.,
  6. Nadine Schwarz, M.S.,
  7. Gudrun Eisenhardt, R.N.,
  8. Götz Geldner, M.D. and
  9. Hinnerk Wulf, M.D.
  1. From the Department of Anesthesiology and Critical Care Medicine, Philipps-University Marburg, Marburg, Germany.
  1. Reprint requests: Astrid M. Morin, M.D., Department of Anesthesiology and Critical Care Medicine, Philipps-University Marburg, Baldingerstrasse, D-35043 Marburg, Germany. E-mail: morin{at}


Background and Objectives Continuous femoral nerve block is a well-accepted technique for regional analgesia after total-knee replacement. However, many patients still experience considerable pain at the popliteal space and at the medial aspect of the knee. The goal of this study is to evaluate whether a psoas compartment catheter provides better postoperative analgesia than a femoral nerve catheter does and whether it is as effective as the combination of a femoral and a sciatic nerve catheter and, thus, improves functional outcome.

Methods Ninety patients who underwent total-knee replacement under standardized general anesthesia participated in this prospective randomized study. Group FEM received a continuous femoral nerve block, group FEM/SCI received a combination of a femoral and a sciatic continuous nerve block, and group PSOAS received a continuous psoas compartment block. Patient-controlled analgesia with piritramide was available for 48 hours. Maximal bending and extending of the knee and walking distance was assessed during the first 7 days. A standardized telephone survey was conducted after 9 to12 months to evaluate residual pain and functional outcome.

Results Postoperative opioid consumption during 48 hours was significantly less in the FEM/SCI group (median: 18 mg; 25th/75th percentile: 6/40) compared with the FEM group (49 mg; 25/66) and the PSOAS group (44 mg; 30/62) (P =.002). Postoperative pain scores were not different, and no differences occurred with respect to short-term or long-term functional outcome.

Conclusion The FEM/SCI catheter is superior to FEM and PSOAS catheter with respect to reduced analgesic requirements after total-knee replacement, but functional outcome does not differ with those 3 continuous regional analgesia techniques.

  • Femoral nerve block
  • Sciatic nerve block
  • Lumbar plexus block
  • Psoas compartment block
  • Continuous peripheral nerve block
  • Total-knee replacement

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