Duration of analgesia is similar when 15, 20, 25 and 30 mL of ropivacaine 0.5% are administered via a femoral catheter

Abstract

P Pu ur rp po os se e: : This dose-response study was designed to determine the most appropriate dose of ropivacaine 0.5% injected via an indwelling femoral catheter for perioperative peripheral analgesia for total knee replacement (TKR).M Me et th ho od ds s: : 84 patients were allocated randomly to four groups and received, via a femoral catheter, either 15, 20, 25 or 30 mL of ropivacaine 0.5% in a double-blind fashion. An anterior sciatic block with 20 mL bupivacaine 0.5% was also performed. The evolution of sensory block of femoral, obturator and lateral femoral cutaneous nerves and motor block of femoral nerve were tested every five minutes during the first 30 min. The percentage of patients with complete sensory block of both femoral and obturator nerves determined success rate. General anesthesia was then induced. After surgery, patient-controlled analgesia (PCA) with ropivacaine 0.2% was available via the femoral catheter. The interval between the initial injection and the first PCA administration determined duration of action.R Re es su ul lt ts s: : The duration of action was not different between the four solutions tested i.e., 534 ± 379 min for 15 mL, 799 ± 364 min for 20 mL, 624 ± 342 min for 25 mL and 644 ± 266 min for 30 mL. The percentage of patients with complete sensory femoral and obturator blocks was, respectively, 60%, 95%, 85% and 70% for 15, 20, 25 and 30 mL (P = 0.008/15 mL vs 20 mL).C Co on nc cl lu us si io on n: : Although there is no difference in duration of analgesia, because of better sensory spread, 20 mL of ropivacaine 0.5% appears to be the most appropriate dose for peripheral analgesia after TKR. 60 %, 95 %, 85 % et 70 % pour les doses de 15, 20, 25 et 30 mL (P = 0,008/15 mL vs20 mL Objectif

Gabapentin decreases morphine consumption and improves functional recovery following total knee arthroplasty

“…The use of GBP with regional anesthesia (spinal or epidural analgesia, and peripheral nerve blocks) as the primary surgical modality, provides a robust neuronal blockade for hours after surgery. Spinal anesthesia was chosen as the primary anesthetic modality and the peripheral (ie, femoral and sciatic) nerve blocks were adjuncts for postoperative pain (12±3 h) (38). Table 2 and Figure 1 demonstrate the effectiveness of our spinal and peripheral nerve blockade regimen.…”

“…Femoral and sciatic nerve blocks were performed using a nerve stimulator and ultrasound technique to localize the nerves at less than 0.5 mA. Ropivacaine 0.5% (20 L), with an approximate mean duration of action of 15 h, was deposited adjacent to each nerve (38). Spinal anesthesia was performed in the lateral decubitus or sitting position.…”

A procedure‐specific systematic review and consensus recommendations for postoperative analgesia following total knee arthroplasty

“…One study also showed that the time to first analgesic request was significantly longer with parecoxib compared with placebo [14] (see Table 1). [19] Inconclusive Ropivacaine via femoral catheter [117] NS Bupivacaine via femoral catheter [35] NS Spinal diamorphine [42] NS Spinal morphine [43] NS Lumbar epidural ketamine [52] NS Lumbar epidural ropivacaine [50,53] Inconclusive Route and method of drug administration IV vs IM strong opioid [23] NS IV PCA vs IM strong opioid [24] IM superior for moderate pain scores Surgical approaches Medial trivector approach [61], Subvastus approach [62], vs parapatellar approach NS Posterior cruciate ligament (PCL) surgery during TKA: different surgical approaches [63] PCL released surgery inferior to other approaches Midvastus approach vs medial parapatellar approach [64] Midvastus superior at rest and on movement…”

Strategies Aimed at Preventing Chronic Post-surgical Pain: Comprehensive Perioperative Pain Management after Total Joint Replacement Surgery

“…A longer-acting solution of ropivacaine 0.5% (20 mL), deposited adjacent to each nerve, will produce a mean anaesthetic duration of action of 15 hours. 159 Occasionally it becomes difficult to predict the level of motor impairment that accompanies single-shot nerve blocks. This is a significant consideration for patient safety if ambulation on postoperative day 0, or early on postoperative day 1, is desirable.…”