Correspondence  |   February 2018
In Reply
Author Notes
  • University of Virginia, Charlottesville, Virginia (A.S.T.). asterkawi@gmail.com
  • (Accepted for publication October 27, 2017.)
    (Accepted for publication October 27, 2017.)×
Article Information
Correspondence
Correspondence   |   February 2018
In Reply
Anesthesiology 2 2018, Vol.128, 421-422. doi:10.1097/ALN.0000000000001993
Anesthesiology 2 2018, Vol.128, 421-422. doi:10.1097/ALN.0000000000001993
Webb et al. note our conclusion that “the combination of femoral and sciatic nerve blocks provides the best analgesia”1  and assert that it is “not surprising that anesthetizing multiple nerves is superior to blocking a single nerve.” In fact, it was hardly a forgone conclusion that sciatic nerve blocks are necessary, because femoral nerve blocks alone work fairly well and might have proven sufficient, especially when combined with supplemental nonopioid systemic analgesics. Our results clearly show that sciatic nerve blocks significantly augment the benefit of femoral nerve blocks, and—importantly—quantify the effect magnitude.
Webb et al. comment that the incidence of transient peroneal nerve palsy was high in combined femoral-sciatic nerve blocks (7.6%). It is important to recognize that this fragile estimate was based on only six episodes in the femoral-sciatic group and was nearly the same as after periarticular infiltration (6.4%). Given how infrequently peroneal nerve palsy was reported in our underlying studies and the transient nature of the condition, it seems ill-advised to select analgesic strategy based on this minor and rare outcome.
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