As anyone who has undergone knee replacement can attest, the pain following surgery can be severe. The procedure impacts the two main nerves to the knee: the femoral nerve, which affects the front of the knee, and the sciatic nerve, which impacts the back of the knee.
A new anesthesia technique at The Valley Hospital essentially numbs both of these nerves, virtually eliminating pain impulses to the brain and thus pain sensation in the knee.
“To my knowledge, Valley is the only hospital in the area and one of only a few in the country utilizing this combined nerve block technique,” says Anesthesiologist Wendy Silverstein, M.D. Dr. Silverstein worked closely with Joseph Pizzurro, M.D., and Valley’s entire team of orthopedic surgeons, anesthesiologists, nurses, physical therapists and other professional staff to institute this advancement in orthopedic care.
Called femoral/sciatic nerve blocks, the technique is administered in the operating room before surgery. While the patient is lightly sedated, the anesthesiologist inserts a very thin catheter, or tube, into the top of the operative leg, allowing a continuous drip of local anesthetic to travel directly to the femoral nerve.
The catheter remains in place for up to three days, when severe pain has subsided and most patients are discharged from the hospital. Additionally, the anesthesiologist delivers local anesthetic to the sciatic nerve through a single injection to the operative leg. The sciatic nerve is numbed for about 24 hours to optimize patient comfort. “Together, the two nerve blocks have provided superior, long-term pain relief to our patients while improving functional recovery to the knee,” noted Dr. Silverstein.
The technique offers many advantages over other methods of pain control for total knee replacement surgery, including epidural analgesia, which inserts local anesthetic into the space surrounding the spinal canal. While this previously preferred procedure provides excellent pain management, the epidural must be discontinued shortly after surgery to avoid incompatibilities with postoperative medication, though severe knee pain can last several days. Furthermore, the epidural affects both legs, causing unnecessary weakness in the non-operative leg and hindering physical therapy.
Femoral/sciatic nerve blocks are also safer and more effective than high doses of narcotic medications, which often induce nausea, vomiting, dizziness, depressed breathing and other undesirable side effects.
The femoral/sciatic nerve blocks substantially reduce anesthetic requirements during surgery, and reduce or eliminate the need for intravenous narcotics after surgery.