• Busara Sirivanasandha, Kulwadee Sutthivaiyakit, Thippatai Kerdchan, Suppachai Poolsuppasit, Suwimon Tangwiwat, and Pathom Halilamien.
• Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand. busarasiri@gmail.com.
• BMC Anesthesiol. 2021 Nov 13; 21 (1): 282.

BackgroundThis study compared the effects of adductor canal blocks with those of a low concentration of popliteal-sciatic nerve block (SNB) and dexamethasone as an adjunctive technique for total knee arthroplasties (TKA) in patients susceptible to the adverse effects of NSAIDs.MethodsA prospective, double-blinded, randomized controlled trial was performed in 50 patients susceptible to the adverse effects of NSAIDs undergoing unilateral TKAs. All patients received spinal anesthesia, adductor canal blocks, and periarticular infiltration. The 25 patients in the intervention group received SNB (0.125% bupivacaine [20 ml] and dexamethasone [5 mg]).ResultsThe SNB group significantly had lower median resting pain scores at 6, 12, and 18 h: the control group, 1 (0-4.5), 3 (0-5), and 3 (2-5); the intervention group, 0 (0-0), 0 (0-3), and 1 (0-3); p-values, 0.012, 0.021, and 0.010, respectively. Movement-evoked pain scores at 6, 12, and 18 h were also lower: control group, 3 (0-5.5), 5 (2.5-6.5), and 7 (4-9); intervention group, 0 (0-1.5), 2 (0-4), and 3 (2-5); p-values, 0.019, 0.005, and 0.001, respectively. There were no differences in motor function. Moreover, the mean morphine consumption 24 h was also reduced in the SNB group: control group, 3.80 ± 2.48 mg; intervention group, 1.96 ± 2 mg; p-value, 0.005.ConclusionFor patients susceptible to the adverse effects of NSAIDs, a low concentration of SNB and dexamethasone is an effective adjunctive technique for early postoperative pain control (especially on movement) following TKAs, without an increase in motor weakness.Trial RegistrationClinicalTrials.gov , NCT03486548 , Registered 3 April 2018.© 2021. The Author(s).

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