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Departments of Anesthesiology and Orthopedic Surgery; Frederiksberg Hospital; University of Copenhagen; Denmark; Dusanka.zaric{at}frh.regionh.dk
In Response:
We thank Navas et al. (1) for their interest and questions about our study (2). If the patients experience pain after total knee replacement, such pain often starts, when the effect of the initial blocks have worn off, so that extra bolus doses are needed. The pain can start in either area (femoral or sciatic), but in our experience, supplemental injections are often necessary for both nerves.
The main nerve supply to the knee joint comes from the femoral nerve. Consequently, in most papers describing peripheral nerve blocks for analgesia after total knee replacement, the authors recommend continuous femoral nerve block alone (3,4). As we discuss in our paper, femoral nerve block alone was not sufficient in our patient population. The use of lower concentration of ropivacaine for the sciatic nerve block in our study was empirical, the sciatic nerve blockade with higher concentration of ropivacaine results in intense motor blockade that impedes mobilization on the first postoperative day. In our experience the patients do not complain more about pain in the sciatic nerve area with the described protocol.
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