Clinical Research Article Korean J Anesthesiol 2012 May 62(5): 448-453 http://dx.doi.org/10.4097/kjae.2012.62.5.448 A comparison of femoral/sciatic nerve block with lateral femoral cutaneous nerve block and combined spinal epidural anesthesia for total knee replacement arthroplasty Jong Hae Kim1, Myoung Rae Cho2, Si Oh Kim3, Jung Eun Kim1, Dong Keun Lee1, and Woon Seok Roh1 Departments of 1Anesthesiology and Pain Medicine, 2Orthopedic Surgery, School of Medicine, Catholic University of Daegu, 3Department of Anesthesiology and Pain Medicine, Kyungpook National University School of Medicine, Daegu, Korea Background: Several factors, such as compromised cardiopulmonary function, anticoagulative therapy, or anatomical deformity in the elderly, prevent general anesthesia and neuraxial blockade from being conducted for total knee replacement arthroplasty (TKRA). We investigated the efficacy of femoral/sciatic nerve block with lateral femoral cutaneous nerve block (FSNB) as an alternative procedure in comparison with combined spinal epidural nerve block (CSE) in patients undergoing TKRA. Methods: In this observational study, 80 American Society of Anesthesiologists physical status I-III patients scheduled for elective unilateral TKRA underwent CSE (n = 40) or FSNB (n = 40). Perioperative side effects, intraoperative medications, duration and remaining amount of intravenous patient-controlled analgesia, rate of satisfaction with the surgical anesthesia and postoperative analgesia, willingness to recommend the same surgical anesthesia and postoperative analgesia to others, and postoperative visual analog scale pain scores were assessed. Statistical analysis was done using Chi-square test, Student’s t-test, and repeated-measures analysis of variances. Results: There was significantly more use of antihypertensives, analgesics, and sedatives in the FSNB group. There were no significant differences of perioperative side effects, duration and remaining amount of intravenous patient- controlled analgesia, rate of satisfaction with the surgical anesthesia and postoperative analgesia, willingness to recommend the same surgical anesthesia and postoperative analgesia to others, and postoperative visual analog scale scores between the two groups. Conclusions: FSNB with a sophisticated use of antihypertensives, analgesics, and sedatives to supplement insufficient block offers a practical alternative to CSE for TKRAs. (Korean J Anesthesiol 2012; 62: 448-453) Key Words: Epidural anesthesia, Femoral nerve, Nerve block, Sciatic nerve, Spinal anesthesia, Total knee replacement. Received: May 20, 2011. Revised: 1st, July 12, 2011; 2nd, September 13, 2011. Accepted: September 22, 2011. Corresponding author: Woon Seok Roh, M.D., Ph.D., Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu, 3056-6, Daemyeong-4dong, Nam-gu, Daegu 705-718, Korea. Tel: 82-53-650-4504, Fax: 82-53-650-4517, E-mail: usno@cu.ac.kr CC This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright ⓒ the Korean Society of Anesthesiologists, 2012 www.ekja.org