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The role of sciatic nerve block to complement femoral nerve block in total knee arthroplasty: a meta-analysis of randomized controlled trials

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Abstract

Introduction

Femoral nerve block (FNB) appears to have higher postoperative analgesic benefits compared with the patient-controlled analgesia (PCA) in total knee arthroplasty (TKA). However, the role of sciatic nerve block (SNB) as a complement to FNB remains controversial. We performed a meta-analysis assessing the benefits of the SNB as a complement to FNB, as well as comparing the efficacy of single-injection versus continuous SNB in TKA.

Methods

Our group conducted a systematic literature search in PubMed, EMBASE and Google Scholar. We retrieved randomized trials comparing either SNB versus placebo or continuous versus single-injection SNB. The intervention group was the use of SNB as a complement to FNB, while the control group was FNB alone. Pain score at rest and movement (at 4, 12, 24, 48 and 72 h), patient-controlled intravenous opioid consumption, length of hospital stay, and incidence of nausea were extracted from each study. Random-effects model was used for meta-analysis and standardized mean difference (SMD) was used as the effect size.

Results

Ten articles comprising 514 patients were included to compare the effects of SNB combined with FNB versus FNB alone. Interventional group was found to significantly reduce pain score at for 4 h (SMD = − 0.94, 95% CI − 1.42 to − 0.47, P < 0.001, I2 = 76.5%) compared with the control group. Pain score at rest was significantly reduced at movement for 12 h (SMD = − 0.29, 95% CI − 0.54 to − 0.04, P = 0.02, I2 = 0%). Opioid consumption was significantly reduced at 24 (SMD = − 0.60, 95% CI − 1.01 to − 0.17, P = 0.01, I2 = 69.1%) and 48 h (SMD = − 1.04, 95% CI − 1.46 to − 0.61, P < 0.001, I2 = 43.4%) after TKA using SNB as a complement to FNB. Three articles were additionally meta-analyzed to compare the efficacy of single-injection (n = 79) versus continuous SNB (n = 79), being the latter one significantly associated with less pain score at 24 (SMD = -0.77, 95% CI − 1.10 to − 0.45, P < 0.001, I2 = 0%) and 48 h (SMD = − 0.69, 95% CI − 1.01 to − 0.36, P < 0.001, I2 = 0%), but not at 12 h (SMD = − 0.34, 95% CI − 0.73 to − 0.06, P = 0.10, I2 = 0%).

Conclusions

This meta-analysis provides evidence-based supports to the benefits of SNB as a complement to FNB in TKA. The combination sciatic–femoral nerve block appears to be the optimal choice for patients in high risk of postoperative opioids consumption or acute pain after TKA.

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Author information

Author notes

  1. Andres Zorrilla-Vaca

    Present address: Faculty of Health, Universidad del Valle School of Medicine, Cali, Colombia

Authors and Affiliations

  1. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Phipps 455, Baltimore, MD, USA

    Andres Zorrilla-Vaca & Jinlei Li

  2. Faculty of Health, Universidad del Valle School of Medicine, Cali, Colombia

    Jinlei Li

  3. Department of Anesthesiology, Yale University, Yale New Haven Hospital, New Haven, CT, USA

    Jinlei Li

Authors
  1. Andres Zorrilla-Vaca
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  2. Jinlei Li
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Contributions

AZ-V is the archival author and contributed to the design of the study, data collection, conducting the study, quality control, analyzing the data, interpretation of the data, and writing the manuscript. JL also helped to write the manuscript.

Corresponding author

Correspondence to Andres Zorrilla-Vaca.

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Conflict of interest

Andres Zorrilla-Vaca receives research funding from the Colombian Society of Anesthesiology and Reanimation. Jinlei Li: None.

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Zorrilla-Vaca, A., Li, J. The role of sciatic nerve block to complement femoral nerve block in total knee arthroplasty: a meta-analysis of randomized controlled trials. J Anesth 32, 341–350 (2018). https://doi.org/10.1007/s00540-018-2480-1

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  • DOI: https://doi.org/10.1007/s00540-018-2480-1

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