If you wish to respond to a paper or other item already published in the BJA, please go to the abstract/full text version of that item and click on the link "E-Letters: Submit a response to the article".
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E-letters: Electronic letters published:
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re: Periarticular analgesia after total knee arthroplasty
- Steven J Fowler, Joel Symons, Paul S. Myles (23 April 2008)
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Re: Epidural analgesia compared with peripheral nerve blockade after major knee surgery
- Avine Lydon, Mark Campbell (13 April 2008)
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Steven J Fowler, Staff Specialist Anaesthetist The Alfred Hospital, Melbourne, Australia, Joel Symons, Paul S. Myles
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We would like to thank Drs Campbell and Lydon for their interest in our study (1). Periarticular and intra-articular infiltration after total knee arthroplasty were intentionally omitted from our systematic review (2) because of lack of suitable randomized trials and variability in the techniques. Toftdahl and colleagues (3) suggest that periarticular infiltration may indeed represent an alternative to peripheral nerve blockade, although we note that there was a 5% incidence of serious local complications in the periarticular infiltration group. This is of concern and would likely influence the acceptance of this technique by both surgeons and anaesthetists in our region. We do however await further controlled randomized trials comparing local infiltration with peripheral nerve blockade. Steven J Fowler FCARCSI FANZCA Staff Specialist Anaesthetist The Alfred Hospital Melbourne, Australia Email: steven.fowler@alfred.org.au 1. Campbell M, Lydon A. Re: Epidural analgesia compared with peripheral nerve blockade after major knee surgery (BJA e-letter submitted 3 Apr 2008) 2. Fowler SJ, Symons J, Sabato S, Myles PS. Epidural analgesia compared with peripheral nerve blockade after major knee surgery: a systematic review and meta-analysis of randomised trials. Br J Anaesth 2008; 100: 154 -64 3. Toftdahl K, Nikolajsen L, Haraldsted V, Madsen F, Tonnesen EK, Soballe K. Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty: a randomised clinical trial. Acta Orthop 2007; 78: 172-9 Conflict of Interest:None declared |
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Avine Lydon , Mark Campbell
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Editor- We read with interest the meta analysis of epidural analgesia compared with peripheral nerve blockade (PNB) after major knee surgery (1). The authors limit their discussion of PNB to the femoral and sciatic nerves, and the lumbar plexus, using a variety of techniques. Our institution is currently evaluating the use of periarticular infiltration of ropivicaine, morphine and adrenaline during surgery as an alternative to both epidurals and large nerve blockade. This emerging technique may combine the advantages of PNB as discussed by the authors (unilateral analgesia, less motor block and hypotension, and less potential for central neuraxial injury) without the disadvantages (neuropraxia, catheter related problems such as bacterial colonisation, and quadriceps weakness on the operative side). Results from as yet very few studies on periarticular infiltration suggest that it is an effective technique, both alone (2) and when compared to femoral nerve blockade (3) in patients undergoing total knee arthroplasty. The results of further studies of periarticular infiltration may challenge the authors’ conclusion that a PNB technique that includes femoral block represents the best balance between analgesia and side effects as a choice of postoperative analgesic technique for major knee surgery. M. Campbell A. Lydon * Dublin, Ireland. * E-mail: avinelydon@hotmail.com 1 Fowler SJ, Symons J, Sabato S, Myles PS. Epidural analgesia compared with peripheral nerve blockade after major knee surgery: a systematic review and meta-analysis of randomised trials. Br J Anaesth 2008; 100: 154-64 2 Vendittoli PA, Makinen P, Drolet P, et al. A multimodal analgesia protocol for total knee arthroplasty. A randomised, controlled study. J Bone Joint Surg Am 2006; 88: 282-9 3 Toftdahl K, Nikolajsen L, Haraldsted V, Madsen F, Tonnesen EK, Soballe K. Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty: a randomised clinical trial. Acta Orthop 2007; 78: 172-9 Conflict of Interest:None declared |
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