RevBrasAnestesiol.2016;66(4):437---438
REVISTA
BRASILEIRA
DE
ANESTESIOLOGIA
PublicaçãoOficialdaSociedadeBrasileiradeAnestesiologia www.sba.com.brLETTERS
TO
THE
EDITOR
Postoperative
analgesia
after
total
knee
arthroplasty
Analgesia
no
pós-operatório
de
artroplastia
total
de
joelho
DearEditor,
WereadwithgreatinterestthearticleofWangetal.1
con-cerningtheuse ofcontinuouslocalanestheticinfusionvia
cathetersplaced withultrasoundguidedandnerve
stimu-latorbesidefemoralnerveforpostoperativeanalgesiaafter
totalkneearthroplasty(TKA).Wecongratulatethemonthe
presentationofthearticle.However,wewouldliketoadd
somecomments.
We agree with author that rehabilitation after TKA
is an important determinant of post-operative functional
reconstructionof knee.1 Physical therapy withearly joint
mobilization is also an important aspect to achieve good
results.ThereforepainmanagementafterTKAis essential
andmayeffectsuccessrateofsurgery.
Regional analgesia is commonly used for TKA as it has
lesserside-effectsandbetteranalgesiawhencomparedwith
traditional oral analgesics.2 Among the regional analgesia
techniques, continuous epidural analgesia and continuous
femoralblockanalgesiaarepreferredtouseafterTKA.3
Continuousepiduralanalgesiahasdefiniteeffectiveness,
andafewsystemicsideeffects.Ithasbeenwidelyapplied
in clinical practice. However, this procedure still causes
respiratorydepression,hemodynamicinstability, intestinal
obstruction, urinaryretention, pruritus, motor block, and
walklimitation.4 Continuousfemoral nerveblockhas
spe-cial advantage for the analgesia in postoperative pain.5,6
It is that this technique may have less side effects than
theothersbutcontinuousepiduralanalgesiamaybemore
successfulwithpostoperativepainmanagement.
Anatomically, thekneejointtakesitsnervesupply
pri-marily from the femoral nerve; however, there seems to
be an important component from the sciatic nerve that
evinces aspain related tocalf and leg.2 Previous studies
areinconclusiveconcerning thenecessity of sciatic nerve
block andalsotherearenearlyan equal numberof
stud-iesdiscussingadequateandinadequateblockwithfemoral
nerve block alone.7 However a study of Zugliani et al.
demonstratedthatsciaticnerveblockwithonesingledose
associatedwith continuousfemoral nerve block improved
significantly the quality of postoperative analgesia in
TKA.8
Wethinkthatsciaticnerveblockandfemoralnerveblock
maybeperformedtogetherorsingleshotsciaticnerveblock
maybeaddedforinsufficientfemoralnerveblockandalso
theuseofultrasound-guidedcontinuousfemoralnerveblock
forpostoperativepaincontrolinTKAmaybeagood
alter-nativetocontinuousepiduralanalgesia.
Conflicts
of
interest
Theauthorsdeclarenoconflictsofinterest.
References
1.Wang F, Liu L, Hu Z, et al. Ultrasound and nerve stimulator guidedcontinuousfemoralnerveblockanalgesiaaftertotalknee arthroplasty: a multicenter randomized controlled study.Rev BrasAnestesiol.2015;65:14---20.
2.Shanthanna H, Huilgol M, Maniar A. Comparative study of ultrasound-guidedcontinuousfemoralnerveblockadewith con-tinuousepidural analgesiafor painrelief followingtotal knee replacement.IndianJAnaesth.2012;56:270---5.
3.Al-ZahraniT,DoaisKS,AljassirF,etal.Randomizedclinicaltrial ofcontinuousfemoralnerveblockcombinedwithsciaticnerve blockversusepiduralanalgesiaforunilateraltotalknee arthro-plasty.JArthroplasty.2015;30:149---54.
4.Nora FS. Target-controlled total intravenous anesthesia asso-ciated with femoral nerve block for arthroscopic knee meniscectomy.RevBrasAnestesiol.2009;59:131---41.
5.GuirroU,TambaraE,MunhozF.Femoralnerveblock:assesment ofpostopratif analgesiainarthroskopicanteriorcruciate liga-mentreconstruction.BrJAnaesth.2013;63:483---91.
6.Aytac¸ S¸, Atalan G, Gülen G, et al. Comparison of femoral nerve block byneurostimulator accompanied withultrasound and without ultrasound in knee artroplsty. J Clin Anal Med. 2015;6:208---11.
7.WeberA,FournierR,VanGesselE,etal.Sciaticnerveblockand theimprovementof femoralnerveblockanalgesiaaftertotal kneereplacement.EurJAnaesthesiol.2002;19:834---6.
8.ZuglianiAH,Verc¸osaN,AmaralJ,etal.Controlofpostoperative painfollowingtotalkneearthroplasty:isitnecessarytoassociate sciaticnerveblocktofemoralnerveblock?RevBrasAnestesiol. 2007;57:514---24.
0104-0014/©2015SociedadeBrasileiradeAnestesiologia.PublishedbyElsevierEditoraLtda.ThisisanopenaccessarticleundertheCC
438 LETTERSTOTHEEDITOR
SukruTekindura, MemduhYetimb,∗
aGulhaneMilitaryMedicalAcademy(GMMA),Department
ofAnesthesiologyandReanimation,Ankara,Turkey bVanMilitaryHospital,Van,Turkey
∗Correspondingauthor.
E-mail:stekindur@hotmail.com(M.Yetim).
Availableonline27November2015
http://dx.doi.org/10.1016/j.bjane.2015.02.005
BJA:
a
bit
of
history
RBA:
um
pouco
de
história
DearEditor:
‘‘Inote withsatisfactionthat in January 2016 the
thirty-ninth year of uninterrupted activity as a member of the
Editorial Board of the Brazilian Journal of Anesthesiology
(BJA)isstarting.’’InvitedbytheformerChiefEditorMario VillamilBentoGonc¸alves,IjoinedtheBoardinJanuary1978 withthetaskofimplementingthe‘‘BibliographicalReview’’ section,withabstractsofpaperspublishedininternational
journals of the specialty. In January 1980, with the late
Masami Katayama, there were significant changes to the
Journal layout and presentation. The ‘‘Educational
Num-bers’’,whichIhadtheprivilegeofcoordinating,invitedby
Masami, have provided ammunition to the Education and
TrainingCentersoftheSBAwitheducationalmaterialabout
thescientificbasisofthe specialty,fillingthough partially
aneedinthisarea.Masamiheldthepositionwithenviable
proficiencyuntil1988,establishingguidelinesforthefuture oftheJournal.
AntonioLeiteSilvaFilho(1989---1994),LuizMarciano
Can-giani (1995---2003), Judymara Lauzi Gozzani (2004---2009),
MárioJosédaConceic¸ão(2010---2015)and,currently,Maria AngelaTardellifollowedhisfootsteps.
Allhonor me withthe invitationtoremain part ofthe
EditorialBoard,andsoIwasabletowitnesstheeffortand
competenceofeveryoneinthesafeconductionofthemain
scientificdisseminationorganoftheSBA.
In 1990, as Chairman of the Board of the SBA, I had
anotherprivilege:toforwardtheBJAinternationalexposure
processin which was editedan annual numberin English
witharticles selectedby theEditorial Board that year. It
wasthe‘‘BrazilianJournalofAnesthesiology---International
Issue’’,Volume1,1990.Unfortunatelyin1990management,
the‘‘CollorPlan’’causedproblemsforthefinancial
situa-tionoftheSBA,notallowingthepublicationoftheBrazilian
Journalfirstissuethatyear,whichhappenedhoweverearly
in thenextadministration, under thechairmanshipof my
friendCarlosAlbertoSouzaMartins.
Duringall theseyears, Ifollowed the long and painful
process of the BJA indexation and modernization. It has
neverbeen alackof braveryanddedicationinany ofthe
Editors for the Journal to reach the situation of
excel-lenceandinternationalrecognitionthatboaststoday.And
Icannotbutexpressmyfeelingofgreatsatisfactiontobe
abletohavecontributedoverthisperiodwithonehundred
ninety-sevenpublicationsintheBJA,comprisingclinicaland
experimental research papers, review articles, editorials,
andothers.Because asPlato said:‘‘spoken wordsfly, but
writingremains’’.Andwhenthewritingremainsinamatrix
oftheBJAcaliber,theachievementismuchmorerewarding.
Conflicts
of
interest
Theauthordeclaresnoconflictsofinterest.
JoséRobertoNocitia,b,c
aSociedadeBrasileiradeAnestesiologia(SBA),Riode
Janeiro,RJ,Brazil
bCETHospitalSãoFrancisco,InstitutoSantaLydia,
RibeirãoPreto,SP,Brazil
cWorldFederationofSocietiesofAnaesthesiologists
(WFSA),UnitedKingdom
E-mail:contato@coopanestrp.com.br Availableonline30April2016
