Abstract
Purpose
Sciatic nerve block (SNB) is commonly performed in combination with femoral nerve block (FNB) for postoperative analgesia following total knee arthroplasty (TKA). Despite the fact that 10–20 % of TKA patients require SNB for postoperative posterior knee pain, there are no existing studies that suggest a model to predict the need for SNB. The aim of our study was to develop a prediction tool to measure the likelihood of patients undergoing TKA surgery requiring a postoperative SNB.
Methods
With institutional review board approval, we obtained data from the electronic medical record of patients who underwent TKA at the Cleveland Clinic. A multivariable logistic regression was used to estimate the probability of requiring a postoperative SNB. Clinicians selected potential predictors to create a model, and the potential nonlinear association between continuous predictors and SNB was assessed using the restricted cubic spline model.
Results
In total 6279 TKA cases involving 2329 patients with complete datasets were used for building the prediction model, including 276 (12 %) patients who received a postoperative SNB and 2053 (88 %) patients who did not. The estimated C statistic of the prediction model was 0.64. The nomogram is used by first locating the patient position on each predictor variable scale, which has corresponding prognostic points. The cut-off of 11.6 % jointly maximizes the sensitivity and specificity.
Conclusion
This is the first study to be published on SNB prediction after TKA. Our nomogram may prove to be a useful tool for guiding physicians in terms of their decisions regarding SNB.
Similar content being viewed by others
References
Pfuntner A WL, Stocks C. Most frequent procedures performed in US Hospitals. HCUP Statistical Brief #165. October 2013. Agency for Healthcare Research and Quality, Rockville, MD. Available at: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb165.pdf. Accessed Oct 2013.
Weiss AJ EA, Andrews, RM. Characteristics of operating room procedures in US Hospitals. HCUP Statistical Brief #170. February 2014. Agency for Healthcare Research and Quality, Rockville, MD. Available at: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb170-Operating-Room-Procedures-United-States-2011.jsp. Accessed Feb 2014.
Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am. 2005;87:1487–97.
Lee JJ, Choi SS, Lee MK, Lim BG, Hur W. Effect of continuous psoas compartment block and intravenous patient controlled analgesia on postoperative pain control after total knee arthroplasty. Korean J Anesthesiol. 2012;62:47–51.
Oldmeadow LB, McBurney H, Robertson VJ. Hospital stay and discharge outcomes after knee arthroplasty: implications for physiotherapy practice. Aust J Physiother. 2002;48:117–21.
Indelli PF, Grant SA, Nielsen K, Vail TP. Regional anesthesia in hip surgery. Clin Orthop Relat Res. 2005;441:250–5.
Allen HW, Liu SS, Ware PD, Nairn CS, Owens BD. Peripheral nerve blocks improve analgesia after total knee replacement surgery. Anesth Analg. 1998;87:93–7.
Cook P, Stevens J, Gaudron C. Comparing the effects of femoral nerve block versus femoral and sciatic nerve block on pain and opiate consumption after total knee arthroplasty. J Arthroplasty. 2003;18:583–6.
Ilfeld BM, Ball ST, Gearen PF, Le LT, Mariano ER, Vandenborne K, Duncan PW, Sessler DI, Enneking FK, Shuster JJ, Theriaque DW, Meyer RS. Ambulatory continuous posterior lumbar plexus nerve blocks after hip arthroplasty: a dual-center, randomized, triple-masked, placebo-controlled trial. Anesthesiology. 2008;109:491–501.
Ilfeld BM, Mariano ER, Girard PJ, Loland VJ, Meyer RS, Donovan JF, Pugh GA, Le LT, Sessler DI, Shuster JJ, Theriaque DW, Ball ST. A multicenter, randomized, triple-masked, placebo-controlled trial of the effect of ambulatory continuous femoral nerve blocks on discharge-readiness following total knee arthroplasty in patients on general orthopaedic wards. Pain. 2010;150:477–84.
Weber A, Fournier R, Van Gessel E, Gamulin Z. Sciatic nerve block and the improvement of femoral nerve block analgesia after total knee replacement. Eur J Anaesthesiol. 2002;19:834–6.
Bauer MC, Pogatzki-Zahn EM, Zahn PK. Regional analgesia techniques for total knee replacement. Curr Opin Anaesthesiol. 2014;27:501–6.
Lee RM. Lim Tey JB, Chua NH. Postoperative pain control for total knee arthroplasty: continuous femoral nerve block versus intravenous patient controlled analgesia. Anesth Pain Med. 2012;1:239–42.
Al-Zahrani T, Doais KS, Aljassir F, Alshaygy I, Albishi W, Terkawi AS. Randomized clinical trial of continuous femoral nerve block combined with sciatic nerve block versus epidural analgesia for unilateral total knee arthroplasty. J Arthroplasty. 2015;30:149–54.
Abdallah FW, Chan VW, Gandhi R, Koshkin A, Abbas S, Brull R. The analgesic effects of proximal, distal, or no sciatic nerve block on posterior knee pain after total knee arthroplasty: a double-blind placebo-controlled randomized trial. Anesthesiology. 2014;121:1302–10.
Chan EY, Fransen M, Parker DA, Assam PN, Chua N. Femoral nerve blocks for acute postoperative pain after knee replacement surgery. Cochrane Database Syst Rev. 2014;5:CD009941.
Hunt KJ, Bourne MH, Mariani EM. Single-injection femoral and sciatic nerve blocks for pain control after total knee arthroplasty. J Arthroplasty. 2009;24:533–8.
PhamDang C, Gautheron E, Guilley J, Fernandez M, Waast D, Volteau C, Nguyen JM, Pinaud M. The value of adding sciatic block to continuous femoral block for analgesia after total knee replacement. Reg Anesth Pain Med. 2005;30:128–33.
Sinatra RS, Torres J, Bustos AM. Pain management after major orthopaedic surgery: current strategies and new concepts. J Am Acad Orthop Surg. 2002;10:117–29.
Chase MH, Engelhardt JK, Adinolfi AM, Chirwa SS. Age-dependent changes in cat masseter nerve: an electrophysiological and morphological study. Brain Res. 1992;586:279–88.
Ceballos D, Cuadras J, Verdu E, Navarro X. Morphometric and ultrastructural changes with ageing in mouse peripheral nerve. J Anat. 1999;195:563–76.
Hanks RK, Pietrobon R, Nielsen KC, Steele SM, Tucker M, Warner DS, King KP, Klein SM. The effect of age on sciatic nerve block duration. Anesth Analg. 2006;102:588–92.
Singh JA, Gabriel S, Lewallen D. The impact of gender, age, and preoperative pain severity on pain after TKA. Clin Orthop Relat Res. 2008;466:2717–23.
Fitzgerald JD, Orav EJ, Lee TH, Marcantonio ER, Poss R, Goldman L, Mangione CM. Patient quality of life during the 12 months following joint replacement surgery. Arthritis Rheum. 2004;51:100–9.
Fan Y, Jin J, Sun Z, Li W, Lin J, Weng X, Qiu G. The limited use of a tourniquet during total knee arthroplasty: a randomized controlled trial. Knee. 2014;21:1263–8.
Ejaz A, Laursen AC, Kappel A, Laursen MB, Jakobsen T, Rasmussen S, Nielsen PT. Faster recovery without the use of a tourniquet in total knee arthroplasty. Acta Orthop. 2014;85:422–6.
Abdel-Salam A, Eyres KS. Effects of tourniquet during total knee arthroplasty. A prospective randomised study. J Bone Joint Surg Br. 1995;77:250–3.
Cotter JT, Nielsen KC, Guller U, Steele SM, Klein SM, Greengrass RA, Pietrobon R. Increased body mass index and ASA physical status IV are risk factors for block failure in ambulatory surgery—an analysis of 9342 blocks. Can J Anaesth. 2004;51:810–6.
Gi E, Yamauchi M, Yamakage M, Kikuchi C, Shimizu H, Okada Y, Kawamura S, Suzuki T. Effects of local infiltration analgesia for posterior knee pain after total knee arthroplasty: comparison with sciatic nerve block. J Anesth. 2014;28:696–701.
Tanikawa H, Sato T, Nagafuchi M, Takeda K, Oshida J, Okuma K. Comparison of local infiltration of analgesia and sciatic nerve block in addition to femoral nerve block for total knee arthroplasty. J Arthroplasty. 2014;29:2462–7.
Sullivan M, Tanzer M, Stanish W, Fallaha M, Keefe FJ, Simmonds M, Dunbar M. Psychological determinants of problematic outcomes following total knee arthroplasty. Pain. 2009;143:123–9.
Papakostidou I, Dailiana ZH, Papapolychroniou T, Liaropoulos L, Zintzaras E, Karachalios TS, Malizos KN. Factors affecting the quality of life after total knee arthroplasties: a prospective study. BMC Musculoskelet Disord. 2012;13:116.
Acknowledgments
Received from the Departments of Outcomes Research and Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio. No external funding and no competing interests declared.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
This manuscript was written by the investigators. None of the authors has a personal financial interest in this research.
About this article
Cite this article
Babazade, R., Sreenivasalu, T., Jain, P. et al. A nomogram for predicting the need for sciatic nerve block after total knee arthroplasty. J Anesth 30, 864–872 (2016). https://doi.org/10.1007/s00540-016-2223-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00540-016-2223-0