***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background Several previous surveys have estimated the rate of major complications that occur after regional anesthesia . However , because of the increase in the use of regional anesthesia in recent years and because of the introduction of new techniques , re appraisal of the incidence and the characteristics of major complications is useful . Methods All French anesthesiologists were invited to participate in this 10-month prospect i ve survey based on ( 1 ) voluntary reporting of major complications related to regional anesthesia occurring during the study period using a telephone hotline service available 24 h a day and managed by three experts , and ( 2 ) voluntary reporting of the number and type of regional anesthesia procedures performed using pocket booklets . The service was free of charge for participants . Results The participants ( n = 487 ) reported 56 major complications in 158,083 regional anesthesia procedures performed ( 3.5/10,000 ) . Four deaths were reported . Cardiac arrest occurred after spinal anesthesia ( n = 10 ; 2.7/10,000 ) and posterior lumbar plexus block ( n = 1 ; 80/10,000 ) . Systemic local anesthetic toxicity consisted of seizures only , without cardiac toxicity .  Lidocaine spinal anesthesia was associated with more neurologic complications than bupivacaine spinal anesthesia ( 14.4/10,000 vs. 2.2/10,000 ) . Most neurologic complications were transient . Among 12 that occurred after peripheral nerve blocks , 9 occurred in patients in whom a nerve stimulator had been used . Conclusion This prospect i ve survey based on a free hotline permanent telephone service allowed us to estimate the incidence of major complications related to regional anesthesia and to provide a detailed analysis of these complications Background and purpose — The local infiltration analgesia ( LIA ) technique has been widely used to reduce opioid requirements and to improve postoperative mobilization following total hip arthroplasty ( THA ) . However , the evidence for the efficacy of LIA in THA is not yet clear . We determined whether single-shot LIA in addition to a multimodal analgesic regimen would reduce acute postoperative pain and opioid requirements after THA . Patients and methods — 116 patients undergoing primary THA under spinal anesthesia were included in this r and omized , double-blind , placebo-controlled trial . All patients received oral opioid-sparing multimodal analgesia : etoricoxib , acetaminophen , and glucocorticoid . The patients were r and omized to receive either 150 mL ropivacaine ( 2 mg/mL ) and 0.5 mL epinephrine ( 1 mg/mL ) or 150 mL 0.9 % saline . Rescue analgesic consisted of morphine and oxycodone  as needed . The primary endpoint was pain during mobilization in the recovery unit . Secondary endpoints were pain during mobilization on the day after surgery and total postoperative opioid requirements on the first postoperative day . Results — The levels of pain during mobilization — both in the recovery unit and on the day after surgery— and consumption of opioids on the first postoperative day were similar in the 2 groups . Interpretation — LIA did not provide any extra analgesic effect after THA over and above that from the multimodal analgesic regimen used in this study Background and purpose Pain after total knee arthroplasty ( TKA ) is usually severe , and epidural analgesia or femoral nerve block has been considered to be an effective pain treatment . Recently , local infiltration analgesia ( LIA ) has become increasingly popular but the outcome of this method regarding the analgesic effect has not been fully evaluated . We compared local infiltration analgesia and femoral block with regard to analgesia and morphine dem and during the first 24 h after TKA . Methods 40 patients undergoing TKA under spinal anesthesia were r and omized to receive femoral nerve block ( group F ) or peri- and intraarticular infiltration analgesia ( group LIA ) with a mixture containing ropivacaine , ketorolac , and epinephrine . All patients had access to intravenous patient-controlled analgesia ( PCA ) with morphine postoperatively . Pain intensity at rest and upon movement was assessed on a numeric rating scale ( 0–10 ) on an hourly basis over 24 h if the patients were awake . Results The average pain at rest was marginally lower with LIA ( 1.6 ) than with femoral block ( 2.2 ) . Total morphine consumption per kg was similar between the 2 groups . Ancillary analysis revealed that 1 of 20 patients in the LIA group reported a pain intensity of > 7 upon movement , as compared to 7 out of 19 in the femoral block group ( p = 0.04 ) . Interpretation Both LIA and femoral block provide good analgesia after TKA . LIA may be considered to be superior to femoral block since it is cheaper and easier to perform Local infiltration anesthesia ( LIA ) with anesthetics , steroids , NSAIDS , and epinephrine has been shown to be effective in reducing total knee arthroplasty ( TKA ) postoperative pain . This systematic review explores the functional outcomes of r and omized control trials that have compared the use of LIA with and without steroids during TKA . Five studies with 412 patients met the inclusion criteria , 228 received local infiltration anesthesia with steroids ( LIAS ) and 184 received local infiltration anesthesia without steroids ( LIAWS ) . The use of LIAS in management of postoperative TKA pain has been shown to decrease the length of hospital stay , time required to achieve straight leg raise , and pro-inflammatory signals in patients . Although there is no overwhelming data to suggest LIAS  improves postoperative TKA pain , current literature does support its effectiveness in producing other favorable surgical outcomes Peripheral nerve blocks appear to provide effective analgesia for patients undergoing total knee arthroplasty . Although the literature supports the use of femoral nerve block , addition of sciatic nerve block is controversial . In this study we investigated the value of sciatic nerve block and an alternative technique of posterior capsule local anesthetic infiltration analgesia . 100 patients were prospect ively r and omized into three groups . Group 1 : sciatic nerve block ; Group 2 : posterior local anesthetic infiltration ; Group 3 : control . All patients received a femoral nerve block and spinal anesthesia . There were no differences in pain scores between groups . Sciatic nerve block provided a brief clinical ly insignificant opioid sparing effect . We conclude that sciatic nerve block and posterior local anesthetic infiltration do not provide significant analgesic benefits We evaluated the efficacy of periarticular infiltration of corticosteroid , opioid , and a local anesthetic by comparing pain scores , knee flexion , and quadriceps function on the day of surgery , first postoperative day , day of discharge , and 2 and 4 weeks after surgery between the infiltrated and the noninfiltrated knee in 40 patients undergoing simultaneous bilateral computer-assisted total knee arthroplasty who were r and omized to receive the injection in the right or left knee . In comparison to the noninfiltrated side , the infiltrated knee showed significantly lower pain scores , significantly greater active flexion up to 4 weeks , and superior quadriceps recovery up to 2 weeks after surgery . This simple and inexpensive technique can significantly reduce pain and hasten functional recovery in the first month after total knee arthroplasty Purpose The purpose s of this study were to compare the pain score , systemic opioid consumption , and range of motion ( ROM ) between the group where the use of continuous femoral nerve block ( CFNB ) was discontinued on postoperative day 3 ( POD 3 ) and the group where it was discontinued on POD 7 within an established clinical pathway for postoperative recovery after total knee arthroplasty ( TKA ) and to assess the treatment-related side effects and complications , as well as the functional status of these two groups of patients at 2 years after surgery . Methods This prospect i ve , r and omized , double-blinded trial compared the analgesic efficacy and the functional outcomes between group A ( n = 30 ) where continuous femoral nerve block was performed until POD 3 ( discontinued prior to the initiation of range of motion ( ROM ) exercises ) and group B ( n = 33 ) , where the continuous femoral nerve block was performed until POD 7 ( discontinued during the ROM exercise ) after TKA . Results The resting pain scores of group B were lower than those of group A but there was no significant difference between the two groups ( n.s . , P = 0.387 ) . However , the peak pain scores during ROM exercise , beginning on POD3 through to POD14 , were significantly lower in group B than in group A ( P = 0.001 ) . The cumulative morphine IV-PCA requirements through the POD 2 were similar in the two groups ( n.s . , P = 0.811 ) . However , the cumulative oral oxycodone consumption during hospitalization was significantly lower in group B than in group A , P < 0.0001 . Group B showed significantly greater satisfaction with their method of analgesia than group A ( P = 0.001 ) . Group A scored 2.0 ( 2.0–3.0 ) , whereas group B scored 1.0 ( 1.0–2.0 ) . At 2 years , there was no significant difference in the functional outcomes ( the knee flexion and extension angle , the Knee Society Score , and WOMAC pain , stiffness , and function scale ) . Conclusion The study group who received 7-day continuous femoral nerve block after TKA showed superior analgesia and higher patient satisfaction during the hospital stay than those given 3-day continuous femoral nerve block . Despite the additional time , effort and cost to place and manage continuous femoral nerve catheters , the 7-day continuous femoral nerve block can be recommended as an effective and safe regional component of a multimodal analgesia strategy after TKA.Level of evidence II Numerous postoperative pain protocol s exist for patients undergoing total knee arthroplasty ( TKA ) . We compared the length of stay , early range of motion ( ROM ) , and pain scores of a control group with a femoral nerve block to those of a group with femoral nerve block and local infiltration analgesia following TKA . In a consecutive series of patients undergoing primary TKA at a Veteran 's Administration hospital , 40 patients ( 40 TKAs ) who had local infiltration analgesia were compared to a historical group of 43 patients ( 43 TKAs ) who had a long-acting  femoral nerve block without local infiltration analgesia . Local infiltration analgesia consisted of intraoperative injection of 150 mL of 300 mg ropivacaine , 30 mg ketorolac , and 500 μg epinephrine using 50 mL into each of 3 areas : ( 1 ) posterior capsule , ( 2 ) medial and lateral capsule , and ( 3 ) anterior capsule and subcutaneous tissues . A 17-gauge intra-articular catheter was used to inject an additional 100 mg of ropivacaine on postoperative day 1 . The control group had a single-shot femoral nerve block using 150 mg of ropivacaine with epinephrine . Mean length of stay for the local infiltration analgesia group compared to controls was 3.2±1.4 days vs 3.8±1.6 days , respectively ( P=.03 ) . No significant differences existed in average ROM ( 6 weeks ) , discharge hematocrit , transfusions , and temperature . Mean pain scores were lower in the local infiltration analgesia group on postoperative day 1 ( P=.04 ) , but not on postoperative day 2 or 3 . Maximum visual analog scale scores ( P<.01 ) were reduced in the local infiltration analgesia group . Our early experience with local infiltration analgesia demonstrated a significantly reduced length of stay due to decreased postoperative pain Background Although femoral nerve block provides good analgesia after total knee arthroplasty ( TKA ) , residual posterior knee pain may decrease patient satisfaction . We compared the efficacy of periarticular infiltration analgesia ( PIA ) and sciatic nerve block ( SNB ) for posterior knee pain . Methods Forty-nine patients scheduled for TKA were prospect ively r and omized into the PIA group ( n = 25 ) or SNB group ( n = 24 ) and received general anesthesia with ultrasound-guided femoral nerve block ( FNB ) . In the PIA group , 60 ml 0.5 % ropivacaine and 0.3 mg epinephrine were injected intraoperatively into the periarticular soft tissue before inserting the components . In the SNB group , patients received ultrasound-guided SNB with 20 ml 0.375 % ropivacaine and periarticular infiltration with 20 ml normal saline and 0.3 mg epinephrine . We evaluated postoperative pain scores , posterior knee pain , frequency of rescue analgesics for 36 h , and performance time of PIA and SNB . Results Visual analogue pain scores at 12–24 h were significantly lower in the PIA group than in the SNB group ( p < 0.05 ) . The majority of patients had no posterior knee pain . There were no significant differences between the groups in frequency and time of first administration of rescue analgesics and in side effects . Time for performance of periarticular infiltration was significantly shorter than that for SNB ( p < 0.05 ) . The dose of intraoperative remifentanil was significantly 
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Conclusion FNB-combined SNB  provides superior pain relief and less morphine consumption within the first 24 h compared FNB-combined LIA in total knee arthroplasty .
In addition , there were fewer side effects associated with SNB .