الفهرس 
PainOnly 14 pages are availabe for public view
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Abstract
Background: Regional analgesia is widely used for total knee replacement surgeries (TKR) as it has lesser side effects and better analgesic efficacy when compared with traditional oral analgesics. Peripheral nerve blockade has also been utilized, including continuous infusion techniques. With the use of ultrasound, the needle and catheter placement can be done accurately under real time guidance. This may prove a suitable combinations of nerve blocks for better analgesia after total knee replacement. Aims: Compare the effect of Ultrasound Guided Obturator Versus Sciatic Nerve Block versus both in addition to Continuous Femoral Nerve Block for postoperative analgesia in patients undergoing total knee arthroplasty under general anesthesia. Settings and design: Double blind comparative randomized study performed in tertiary care hospitals. Methods: Patients were assigned randomly by computer generated list into three equal groups; group I: 25 patients received ultrasound guided femoral nerve block (FNB) by continuous infusion together with ultrasound guided obturator nerve single shot block. group II: Another 25 patients received ultrasound guided femoral nerve block by continuous infusion together with ultrasound guided sciatic nerve single shot block. group III: Another 25 patients received ultrasound guided combined obturator and sciatic nerve single shot blocks in addition to continuous femoral nerve block. Statistical analysis: vital data, postoperative analgesic consumption, onset of postoperative analgesic requirement, VAS score during rest and movement, rehabilitation indices and incidence of postoperative complications were compared using ANOVA study with software SPSS v 20.0. Results and conclusion: The addition of obturator and sciatic nerve single shot blocks to continuous femoral nerve block in total knee arthroplasty under general anesthesia has more potent analgesic effect and reduces total narcotic consumption with a significant delay in narcotic requirement when compared with each nerve block alone (either obturator or sciatic) as an additive to continuous femoral nerve block. It also reduces PONV without affecting hemodynamics or causing local anesthetic toxicity.