A 73-year-old female (body weight 64 kg, ASA status III) who suffered from rheumatoid arthritis (RA) for 30 years was scheduled for right total knee arthroplasty (TKA). X-ray of her bilateral knee joint revealed that the joint cavity of bilateral knee joints was narrow and osteophyte formatted in the right side. The patient had hypertension for 6 years and was treated with oral nitrendipine. She also had a history of cerebral infarction 3 years ago. MRI of brain revealed multiple old softening foci in the right basal ganglia region. She had taken aspirin and ginkgo tablets for anticoagulation therapy and prevention of recurrent stroke. The preoperative visual analog scale (VAS) score of this patient was 4. The ultrasound-guided lumbar SNRB plus T12 paravertebral and sacral plexus blocks were performed with 25 mL of 0.4% ropivacaine. Pinprick test was used to confirm the success of these blocks. This technique completely met the analgesic requirement of this patient during surgery. The time of surgery was 1 hour and 12 minutes. With the PCA, the postoperative VAS scores were 0 to 1. This patient discharged on the third day after surgery. No postoperative complication was reported with her.
An 84-year-old female (body weight 56 kg, ASA status III) was scheduled for right artificial femoral head replacement. Her pelvic X-ray revealed a right intertrochanteric fracture. She had hypertension for 35 years and chronic obstructive pulmonary disease (COPD) for 20 years. She took daily oral nifedipine for hypertension, but did not take any treatment for COPD. The result of pulmonary function test showed that the FEV1/FVC was 35% and the bronchodilator test was negative. Cardiac Doppler ultrasonography indicated moderate pulmonary artery hypertension. A chest X-ray revealed pulmonary infection of bilateral lower lobes. Low-molecular-weight heparin was used for prevent thrombus formation at 4000IU per day and stopped 24 hours before surgery. The preoperative visual analogue scale (VAS) score of this patient was 6. The ultrasound guided lumbar SNRB plus T12 paravertebral and sacral plexus blocks were performed on this patient as described in the Methods section, and 25 mL of 0.4% ropivacaine was used for these blocks. The success of these blocks was confirmed by pinprick test. The time of surgery was 42 minutes. She did not complain any painful during surgery and in postanesthesia care unit (PACU). As postoperative analgesia was achieved by patient-controlled analgesia (PCA), the postoperative VAS scores were 0 to 1. This patient discharged on the fifth day after surgery. No postoperative complication was reported with her.