Ist die periphere Nervenblockade des Beines (Femoralis- in Kombination mit anteriorer Ischiadikusblockade) als alleinige Anästhesietechnik eine Alternative zur Periduralanästhesie für arthroskopische Eingriffe am Kniegelenk?

Objective: We compared peripheral nerve blocks (PNB, femoral nerve block together with anterior sciatic nerve block) as sole anaesthetic with epidural anaesthesia (EA) in a randomised study in patients undergoing electivearthroscopic knee surgery with respect to patient satisfaction and time required to perform each procedure. Methods: 99 ASA class I-III patients were randomised to either PNB (20 ml bupivacaine 0.5% + 60 ml prilocaine 1 %) or EA (12 - 20 ml bupivacaine 0.5 %). Endpoints: patient satisfaction with the anaesthetic evaluated by a questionnaire 3 months after the operation, anaesthesia and surgical times, need for additional analgesics and the modified Aldrete-score (global assessment of postanaesthetic condition) at admission in the postanaesthesia care unit. Results: Significantly more patients in the PNB compared to the EA group needed intravenous opioid supplementation (10 vs. 3, p = 0.040). While the patients in the PNB group had a significantly higher modified Aldrete score (9.3 ′ 0.7 vs. 8.8 ′ 0.9, p = 0.0009), assessment (0 = worst, 10 = best) of the induction of PNB or EA respectively, was significantly better rated in the EA compared to PNB group (8.7 ′ 2.1 vs. 6.7 ′ 2.6, p = 0.0024). Assuming that the willingness to undergo the same anaesthetic again reflect overall satisfaction with the procedure satisfaction in both groups was high: 25/26 (PNB) and 27/28 (EA) would have preferred their regional blockade (p = 0.95). Conclusion: Patients in the PNB and EA group both were satisfied with their anaesthetic procedure. While there are obviously differences in favour of the EA, PNB is an alternative in the case of contraindication or patient rejection to EA.