Obturator nerve blockade following '3-in-1' block--the role of motor assessment

Surgeon delivered psoas compartment block in total hip arthroplasty

Total hip arthroplasty is associated with significant postoperative pain. A psoas compartment block is superior to other regional techniques in analgesia post THA. However, traditional methods of delivery are associated with serious complications. We present a technique of a surgeon delivered lumbar plexus block through injection at the portion of the iliopsoas seen intraoperatively. We randomised fifty-three consecutive patients into two groups. The group that received the block had an increased period prior to requesting supplementary analgesia and lower overall pain scores. There were no adverse effects. We have demonstrated the analgesic efficacy of Psoas Compartment Block performed during surgical access for total hip arthroplasty. This technique should be considered in the analgesic regimen for total hip arthroplasty.

Ultrasound guided obturator versus sciatic nerve block in addition to continuous femoral nerve block for analgesia after total knee arthroplasty

Both obturator and sciatic nerve block in combination with femoral nerve block (FNB) have been suggested to be useful in relieving pain after total knee arthroplasty (TKA), compared with FNB alone. We compared their efficacy in this retrospective study. For six consecutive months, patients undergoing unilateral TKA under general anesthesia with continuous FNB plus obturator nerve block (n = 8) or continuous FNB plus sciatic nerve block (n = 8) were investigated. Knee pain was assessed using visual analogue scale (VAS) on the day of surgery and on postoperative days one to three. In addition, we also investigated intraoperative and postoperative morphine consumption. VAS scores and total morphine consumption were not different between the two groups, although patients in the FNB plus sciatic nerve block group were administered less morphine during surgery. Sciatic nerve block with continuous FNB may be superior to obturator nerve block with continuous FNB for analgesia during surgery for TKA.