DOI: https://doi.org/10.36347/sasjm.2025.v11i12.014

Pages: 1214-1225

Background: Regional anesthesia using femoral perineural catheters (FPC) represents a cornerstone technique for postoperative pain management after major knee surgery. While nerve stimulation has traditionally guided catheter placement, ultrasound (US) guidance offers potential advantages through direct visualization of anatomical structures, theoretically improving safety, precision, and analgesic efficacy. Objective: To compare the analgesic efficacy, safety profile, and technical parameters of FPC placement under ultrasound guidance versus traditional nerve stimulation (NS) in patients undergoing major knee surgery. Methods: We conducted a prospective, randomized, single-center study at Douéra University Hospital, Algeria, including 92 patients (aged 18-80 years, ASA I-III) scheduled for major knee surgery (total knee arthroplasty, ligament reconstruction, or arthrolysis). Following informed consent, patients were randomly allocated to receive FPC placement using either ultrasound guidance (US group, n=46) or nerve stimulation (NS group, n=46). The primary outcome was pain intensity assessed using the Visual Analog Scale (VAS) at rest every 6 hours for 48 hours and during mobilization at 48 hours postoperatively. Secondary outcomes included procedure duration, local anesthetic consumption, complications, functional recovery parameters, and patient satisfaction scores. Results: Eighty-five patients completed the study protocol (NS=42, US=43). Baseline demographic and clinical characteristics were comparable between groups. VA score at rest were similar from hour 0 to hour 36 postoperatively. At 48 hours, the US group demonstrated significantly lower pain scores both at rest (1.95±1.1 vs 2.48±1.2; p=0.004) and during mobilization (3.37±1.0 vs 4.02±1.1; p=0.008). Procedure duration was significantly shorter with ultrasound guidance (4.9±1.0 vs 5.5±1.1 minutes; p=0.01). No major complications occurred in either group.