L3 paravertebral block combined with retro-psoas compartment block versus femoral nerve block for postoperative analgesia in total knee arthroplasty: A randomized controlled trial

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Abstract
Background: We proposed that the L3 paravertebral block (PVB) combined with the retro-psoas compartment block (RPCB) would provide a better postoperative analgesia for total knee arthroplasty (TKA) than the femoral nerve block (FNB) alone. Materials and Methods: A total of 66 patients scheduled for TKA were randomly allocated to receive either FNB or L3 PVB-RPCB. Postoperative patient-controlled analgesia with intravenous sufentanil was administered. The primary endpoint was the total sufentanil consumption within the first 24 hour postoperative. Secondary outcomes assessed included pain intensity, sensory dermatomal coverage 20 min after administering the blocks, rescue analgesia requests, satisfaction scores, and the incidence of nausea, vomiting, itching, and posterior knee pain. Results: Patients in the L3 PVB-RPCB group consumed significantly less sufentanil in the first 24-hour post-surgery compared to those who received an FNB, with intake measuring 30 [28 to 33] ug versus 43 [37 to 46] ug, respectively, ( P < 0.01). Furthermore, the pain scores were significantly lower in patients with L3 PVB-RPCB at 6 hour and 12 hours at rest ( P < 0.01), and at 12 hours on movement ( P < 0.01). This group also showed a reduced need for rescue analgesia and experienced less posterior knee pain ( P < 0.01). There were no significant differences in satisfaction scores or in the occurrence of opioid-related side effects. Conclusion: The reduction of sufentanil consumption within the initial 24 hour after TKA demonstrates a beneficial effect of L3 PVB-RPCB over the FNB in providing the postoperative analgesia.

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