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© The Board of Management and Trustees of the British Journal of Anaesthesia [2008]. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Analgesia for primary hip and knee arthroplasty: the role of regional anaesthesia
Specialist Registrar and Fellow in Regional Anaesthesia
Department of Anaesthesia
Ninewells Hospital and Medical School
Dundee DD1 9SY UK
Specialist Registrar
Department of Anaesthesia
Glasgow Royal Infirmary, Glasgow, UK
Consultant Anaesthetist
Department of Anaesthesia
Ninewells Hospital and Medical School
Dundee DD1 9SY UK
Tel: +44 1382 632175 Fax: +44 1382 644914 E-mail: matthew_checketts@yahoo.co.uk
Key Words: Pain after total hip arthroplasty is variable but can be severe; pain after total knee arthroplasty is typically severe. • Regional anaesthesia is associated with lower perioperative morbidity and mortality and may also facilitate improved functional outcome. • Intrathecal morphine and/or lumbar plexus block are the most effective regional analgesic techniques following total hip arthroplasty. • Continuous peripheral nerve blocks provide effective analgesia following total knee arthroplasty with fewer side effects when compared with either continuous epidural or parenteral opioids. • Low concentration local anaesthetic solutions should be used to establish and maintain continuous peripheral nerve blocks in order to minimize motor block in the post-operative period.
| The first 150 words of the full text of this article appear below. |
The development of total hip and knee arthroplasty are regarded as amongst the most significant advances in orthopaedic surgery of the last century. Primary hip and knee arthroplasty are major surgical procedures associated with significant potential perioperative morbidity. Anaesthesia can play a significant role in reducing perioperative morbidity.
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Anaesthetic technique for arthroplasty |
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Anaesthesia for total hip and knee arthroplasty should provide stable intra-operative conditions and allow rapid patient recovery. Analgesic techniques should aim to provide optimal pain relief whilst minimizing side effects such as sedation, post-operative nausea and vomiting (PONV), hypotension, and motor block. There is now good evidence that well-conducted regional analgesia can achieve these aims, leading to improved functional recovery facilitated by more rapid and effective joint rehabilitation.1, 2
Regional anaesthetic techniques have been shown to offer several advantages over general anaesthesia for this type of surgery. Regional anaesthesia is associated with less intra- and post-operative blood loss due to reductions in mean
Multi-modal analgesia
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Epidural anaesthesia and analgesia |
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Spinal anaesthesia and intrathecal opioids |
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Peripheral nerve blocks |
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Innervation of the hip and knee
Continuous peripheral nerve blocks
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Total hip arthroplasty: peripheral nerve blocks |
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Lumbar plexus block (posterior approach)
Femoral nerve block
Fascia iliaca block
Sciatic nerve block
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Total knee arthroplasty: peripheral nerve blocks |
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Femoral nerve block
Sciatic nerve block
Lumbar plexus block
Obturator nerve block
Step-down analgesia