I'm looking for an additional way to block the postoperative pain on the backside of the knee after endoprothesis. The first day seems to be the worst. At the moment wie use a continuous femoralis block and iv-medication. Does anybody know a solution? (We don't want to use epidural anesthesia.)
Thanks
In the past we have used epidurals and fascia iliaca blocks (http://www.gasbag.net/index.php?topic=24.0). We have now found a better solution: direct LA infiltration! As simple as it sounds, it provides better analgesia than the fascia iliaca block woth much less risks than an epidural.
We use 100mL of 0.2% ropivicaine (total dose 200mg) for the avergae to large adult. The surgeon infiltrates thje entire capsule using a long spinal needle. Importantly, the posterior capsule needs to be infiltrated with 40mL before the prosthesis goes in (otherwise access is difficult). After the prothesis is in, the anterior capsule is infiltrated with another 40mL, leaving 20mL for the skin.
This, in addition to a morphine PCA and some IV paracetamol (acetominophen) and parecoxib, and patients often wake up completely pain free. The block seems to last well into the first 24 hours.
Obviously requires surgeon co-operation, but it is well worth training them.
A single shot ciatic block is very good for this situation, with a continuous femural block