Patient‐controlled bolus femoral nerve block after knee arthroplasty: quadriceps recovery, analgesia, local anesthetic consumption

Sakai, Norihiro; Nakatsuka, Miho; Tomita, Tadanori

doi:10.1111/aas.12778

Cited by 9 publications

(7 citation statements)

References 30 publications

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“…Similarly, for truncal catheters, programmed intermittent boluses significantly improved VAS for pain at 48 h in comparison with continuous infusion, the WMD (95% CI) being −0.71 (−1.28 to −0.14), p = 0.015. Although programmed intermittent boluses were studied in two papers involving upper limb catheters, VAS for pain at 48 h and 24 h was inconsistently reported in both papers, and their results were not included in the meta‐analysis for these outcomes . In both bupivacaine and ropivacaine sub‐groups, total local anaesthetic consumption (in bupivacaine equivalent) was reduced with all delivery regimens involving bolus delivery in comparison with continuous infusion.…”

Section: Resultsmentioning

confidence: 99%

“…Although programmed intermittent boluses were studied in two papers involving upper limb catheters, VAS for pain at 48 h and 24 h was inconsistently reported in both papers, and their results were not included in the meta-analysis for these outcomes[40,41]. In both bupivacaine and ropivacaine sub-groups, total local anaesthetic consumption (in bupivacaine equivalent) was reduced with all delivery Pubmed, Ovid SP and Cochrane databases searchedFlow diagram for study selection.…”

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confidence: 99%

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Local anaesthetic delivery regimens for peripheral nerve catheters: a systematic review and network meta‐analysis

et al. 2019

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There are numerous possible techniques for delivering local anaesthetic through peripheral nerve catheters. These include continuous infusions, patient-controlled boluses and programmed intermittent boluses. The optimal delivery regimen of local anaesthetic is yet to be conclusively established. In this review, we identified prospective trials of delivery regimens through peripheral nerve catheters. Our primary outcome was visual analogue scale scores for pain at 48 h. Secondary outcomes were: visual analogue scores at 24 h; patient satisfaction scores; rescue opioid use; local anaesthetic consumption; and nausea and vomiting. Network metaanalysis was used to compare these outcomes. Predefined sub-group analyses were performed. Thirty-three studies enrolling 1934 participants were included. In comparison with continuous infusion, programmed intermittent boluses improved visual analogue pain scores at both 48 and 24 h, the weighted mean difference (95%CI) being À0.63 (À1.12 to À0.14), p = 0.012 and À0.48 (À0.92 to À0.03), p = 0.034, respectively. Programmed intermittent boluses also improved satisfaction scores, the weighted mean difference (95%CI) being 0.70 (0.10-1.31), p = 0.023, and reduced rescue opioid use, the weighted mean difference (95%CI) in oral morphine equivalent at 24 h being À23.84 mg (À43.90 mg to À3.77 mg), p = 0.020. Sub-group analysis revealed that these findings were mostly confined to lower limb and truncal catheter studies; there were few studies of programmed intermittent boluses for upper limb catheters. Programmed intermittent boluses may provide optimal delivery of a local anaesthetic through peripheral nerve catheters. Further research is warranted, particularly to delineate the differences between upper and lower limb catheter locations, which will help clarify the clinical relevance of these findings.

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Section: Resultsmentioning

confidence: 99%

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Local anaesthetic delivery regimens for peripheral nerve catheters: a systematic review and network meta‐analysis

et al. 2019

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“…Several effective modalities are available, but each has its own drawbacks. These modalities including oral opiates, femoral nerve block (FNB) and local infiltration anesthesia [6, 7]. FNB may weaken the quadriceps strength and increase the occurrence of fall.…”

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confidence: 99%

Local anesthetic infusion pump for pain management following total knee arthroplasty: a meta-analysis

Zhang

Chang

2017

BMC Musculoskelet Disord

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BackgroundWe performed a systematic review and meta-analysis of randomized controlled trials (RCTs) were to evaluate the effect and safety of local anesthetic infusion pump versus placebo for pain management following total knee arthroplasty (TKA).MethodsIn September 2016, a systematic computer-based search was conducted in the Pubmed, ISI Web of Knowledge, Embase, Cochrane Database of Systematic Reviews. Randomized controlled trials of patients prepared for primary TKA that compared local anesthetic infusion pump versus placebo for pain management following TKA were retrieved. The primary endpoint was the visual analogue scale (VAS) with rest or mobilization at 24, 48 and 72 h and morphine consumption at 24 and 48 h. The second outcomes are range of motion, length of hospital stay (LOS) and complications (infection, deep venous thrombosis (DVT), prolonged drainage and postoperative nausea and vomiting (PONV)).ResultsSeven clinical studies with 587 patients were included and for meta-analysis. Local anesthetic infusion pump are associated with less pain scores with rest or mobilization at 24 and 48 h with significant difference. However, the difference was likely no clinical significance. There were no significant difference between the LOS, the occurrence of DVT, prolonged drainage and PONV. However, local anesthetic infusion pump may be associated with more infection.ConclusionBased on the current meta-analysis, we found no evidence to support the routine use of local anesthetic infusion pump in the management of acute pain following TKA. More RCTs are still need to identify the pain control effects and optimal dose and speed of local anesthetic pain pump.

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“…Diversas alternativas se han implementado para prevenir una paresia excesiva del cuádriceps, siendo algunas enfocadas en un bloqueo anatómicamente más selectivo y distal de ramos del nervio femoral (NF) [5]- [11] o a una infiltración de anestésicos locales (AL) directamente a nivel periarticular [12], mientras que algunas han intentado optimizar el BCNF [13]- [18]. Entre estas últimas, se ha evaluado el uso de diferentes volúmenes y concentraciones de AL, comparando infusiones continuas con bolos intermitentes, con y sin dosis de demanda, sin encontrar mayores beneficios en términos de preservación de fuerza [14], [15].…”

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“…de la concentración de la infusión en la preservación de fuerza, incluso utilizando concentraciones tan bajas como ropivacaína 0,025%[13], son difíciles de interpretar dado el uso de un bolo inicial de AL de larga duración concentrado.Así, la pregunta de si existe una concentración óptima de AL que permita otorgar analgesia postoperatoria en ATR con BCNF y que, preservando la FC, permita una correcta rehabilitación precoz y prevenga al máximo el riesgo de caídas, aún no se ha respondido.En el presente trabajo presentamos los resultados de un protocolo de estudio de concentraciones diluidas de bupivacaína para BNF en dosis única destinadas a preservar la fuerza del cuádriceps manteniendo la eficacia analgésica en pacientes sometidos a ATR. Luego describimos retrospectivamente, una serie de casos piloto sometidos a ATR con BCNF utilizando una infusión de bupivacaína diluida para luego presentar la experiencia de implementar una solución diluida de levobupivacaína como estándar de infusión en BCNF en ATR en el Hospital Clínico de la Universidad de Chile.métodosEn el contexto de un protocolo de investigación destinado a determinar la concentración efectiva mí-…”

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Cirugía de hombro en posición silla de playa: estrategias y recomendaciones para la prevención de complicaciones isquémicas

Espinoza¹,

Bollini²

2020

Rev. chil. anest.

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Introduction:The commonly used concentrations of local anesthetics (LA) for femoral nerve block (FNB) cause a significant decrease in the quadriceps strength (QS), limiting physiotherapy and determining a risk factor for patient's falls. The use of more dilute solutions could determine the preservation of motor function without impairing analgesia. methods: Five patients scheduled for total knee arthroplasty (TKA) received a preoperative FNB with 20 mL of bupivacaine in decreasing concentrations (0.0875%, 0.075%, 0.0625%, 0.050%, 0.0375%). Sensory block to cold in the anterior knee region, QS, surface electromyography (SEMG) of vastus lateralis (VL), vastus medialis (VM) and rectus femoris (RF) plus were recorded before and 30 minutes after the blockage. Posteriorly, the clinical data of 20 patients who underwent TKA and received a continuous femoral nerve block (CFNB) with bupivacaine in the most dilute concentration that granted sensory blockade and significantly preserved the QS in the previous analysis were retrospectively analyzed. Postoperative pain at 24 and 48 hours, morphine consumption at 24 hours, the ability to successfully perform physiotherapy on the first postoperative day (POD) and reports of falls were rescued from the patients' files. Finally, seventy-five patients that underwent TKA during 2018 who received a CFNB with a similar dilution, but using levobupivacaine, were also retrospectively analyzed. Postoperative pain, need for advanced rescue analgesia, ability to perform physiotherapy, CFNB related complications and reports of patients falls during the first 72 hours post-

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Patient‐controlled bolus femoral nerve block after knee arthroplasty: quadriceps recovery, analgesia, local anesthetic consumption

Abstract: Continuous femoral nerve block followed by PCFNB does not improve quadriceps strength recovery time compared to cFNB alone after total knee arthroplasty, but similar analgesic effects were demonstrated with reduced levobupivacaine consumption.

Cited by 9 publications

References 30 publications

Local anaesthetic delivery regimens for peripheral nerve catheters: a systematic review and network meta‐analysis

Local anaesthetic delivery regimens for peripheral nerve catheters: a systematic review and network meta‐analysis

Local anesthetic infusion pump for pain management following total knee arthroplasty: a meta-analysis

Cirugía de hombro en posición silla de playa: estrategias y recomendaciones para la prevención de complicaciones isquémicas

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