The Continuous Femoral Nerve Block Catheter for Postoperative Analgesia: Bacterial Colonization, Infectious Rate and Adverse Effects

Cuvillon, Philippe; Ripart, Jacques; Lalourcey, Laurent; Veyrat, E; L'Hermite, J; Boisson, Christophe; Thouabtia, Ezzedine; Eledjam, J.J.

doi:10.1097/00000539-200110000-00050

Cited by 272 publications

(157 citation statements)

References 11 publications

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“…Although we did not observe permanent nerve damage in the patients in the femoral nerve block group, the rates in two series ranged from 0.1% to 0.4% [10,24]. Even if our study was not adequately powered (210 patients were needed) to compare DVT rates, earlier and improved mobilization with PAI may reduce venous stasis and thrombosis.…”

Section: Discussionmentioning

confidence: 63%

Periarticular Injection in Knee Arthroplasty Improves Quadriceps Function

Chaumeron

Audy

Drolet

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background The postoperative analgesic potential of periarticular anesthetic infiltration (PAI) after TKA is unclear as are the complications of continuous femoral nerve block on quadriceps function. Questions/purposes We asked (1) whether PAI provides equal or improved postoperative pain control in comparison to a femoral nerve block in patients who have undergone TKA; and (2) if so, whether PAI improves early postoperative quadriceps control and facilitates rehabilitation. Methods We randomized 60 patients to receive either PAI or femoral nerve block. During the first 5 days after TKA, we compared narcotic consumption, pain control, quadriceps function, walking distance, knee ROM, capacity to perform a straight leg raise, and active knee extension. Medication-related side effects, complications, operating room time, and hospitalization duration were compared.

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Section: Discussionmentioning

confidence: 63%

Periarticular Injection in Knee Arthroplasty Improves Quadriceps Function

Chaumeron

Audy

Drolet

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…Fortunately, the reported incidence of local inflammatory signs was only 3%. Cuvillon et al 27 prospectively reported an incidence of 57% of colonized femoral catheters and only 1.5% of bacteremia. Similarly, the risk of epidural infection is low in the pediatric population undergoing short-term perioperative treatment.…”

Section: Adverse Eventsmentioning

confidence: 99%

Continuous peripheral nerve blocks for postoperative analgesia in children: feasibility and side effects in a cohort study of 339 catheters

Dadure

Bringuier

Raux³

et al. 2009

Can J Anesth/J Can Anesth

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Introduction Perioperative continuous peripheral nerve blocks (CPNB) are increasingly being used in children. Only one previous study has reported adverse events of CPNB in a high number of pediatric cases. We evaluated the indications, block efficacy, and adverse events related to CPNB in children. Methods All CPNBs that were performed in children for postoperative analgesia over a 5-year period at the Montpellier University Hospital in France were included in this study. The first bolus dose and the continuous doses of local anesthetic were not standardized. In the postoperative period, demographic data, quality of analgesia, amount of rescue analgesic medication, child/parent satisfaction, and adverse events were recorded in our Departmental Regional Anesthesia registry. Results A total of 339 catheters were evaluated in 292 children ASA physical status I to III. The median age was 8 yr (0.6-17 yr) and the median weight was 28 kg (7-116 kg). The main surgical indications were hip, femoral, or tibial osteotomies (44.5%) and club foot repair (27.4%). The local anesthetics used were either bupivacaine or ropivacaine. The mean volume of the local anesthetic bolus dose was 0.49 ± 0.16 mL Á kg -1 , and the mean regimen of local anesthetic continuous infusion was 0.11 ± 0.04 mL Á kg -1 Á hr -1 . The median duration of CPNB was 61.6 hr (range 0-264 hr). Pain relief, which was evaluated with the children at rest, was considered optimal in the majority of patients throughout the study period. The Children and Infants Postoperative Pain Scale (CHIPPS) was used in children age 0-6 yr and the Visual Analog Pain Scale (VAS) was used in children 7 yr and older. There were no major adverse events. There were 211 minor adverse events recorded in 153 CPNBs (45.1%). The most frequently reported complication (20.1%) involved mechanical problems with the catheter, followed by nausea and vomiting (14.7%). Conclusion CPNBs are indicated after orthopedic surgery in children. Our results demonstrate that CPNBs are feasible in the pediatric setting, and in skilled hands, they promote prolonged analgesia in the majority of patients without major adverse events. The most common minor adverse events are catheter-related mechanical problems and postoperative nausea and vomiting.

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“…However, this requires placement of a perineural catheter, 11,12 continuous infusion of local anesthetic, inconvenience of carrying catheter and local anesthetic reservoir/pump, infusion management and catheter site care, infection, leakage, accidental dislocation, and cost and maintenance of equipment. 11,13 Liposome bupivacaine (bupivacaine liposome injectable suspension; EXPAREL ® ; Pacira Pharmaceuticals, Inc., USA) is a multivesicular formulation of bupivacaine indicated for administration into the surgical site to produce postsurgical analgesia. 14 Liposome bupivacaine has been shown to provide postsurgical analgesia across a range of surgical models, with a safety profile that is similar to that of bupivacaine HCl.…”

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confidence: 99%

Liposome Bupivacaine Femoral Nerve Block for Postsurgical Analgesia after Total Knee Arthroplasty

et al. 2016

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Background The authors evaluated the efficacy of liposome bupivacaine in a femoral nerve block (FNB) after total knee arthroplasty. Methods Part 1: subjects received FNB with 20 ml liposome bupivacaine (67, 133, or 266 mg) or placebo. Part 2: subjects were randomized to FNB with liposome bupivacaine 266 mg or placebo. The primary outcome measure was area under the curve of the numeric rating scale score for pain intensity at rest through 72 h (AUC NRS-R0–72) with imputed scores after rescue medication. Results In part 1, FNB with liposome bupivacaine 266 mg (n = 24) resulted in analgesia similar to that obtained with 133 mg and was chosen for part 2. In part 2, least-squares mean (standard error) AUC NRS-R0–72 was lower with liposome bupivacaine 266 mg (n = 92) than with placebo (n = 91; 419 [17] vs. 516 [17]; P < 0.0001). This outcome remained unchanged in a post hoc analysis without score imputation (221 [12] vs. 282 [12]; P = 0.0005). Least-squares mean AUC NRS-R with imputed scores was lower with liposome bupivacaine during each 24-h interval (0 to 24, 24 to 48, and 48 to 72 h) after surgery; AUC NRS-R without imputed scores was lower during the 0- to 24-h and 24- to 48-h intervals. The liposome bupivacaine group had lower mean total opioid use (76 vs. 103 mg morphine; P = 0.0016). Pain was sufficiently severe to require second-step rescue with opioids via intravenously administered patient-controlled analgesia in 92% of liposome bupivacaine patients and 81% of placebo patients. With patient-controlled analgesia and other forms of rescue analgesia, mean NRS scores with activity were moderate in both liposome bupivacaine and placebo groups throughout the part 2 study period. Incidence of adverse events was similar between the groups (part 1: 90 vs. 96%; part 2: 96 vs. 96%, respectively). Conclusion FNB with liposome bupivacaine (266 mg) resulted in modestly lower pain scores and reduced opioid requirements after surgery, with an adverse event profile similar to placebo.

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The Continuous Femoral Nerve Block Catheter for Postoperative Analgesia: Bacterial Colonization, Infectious Rate and Adverse Effects

Abstract: In this prospective study, continuous femoral nerve catheters were effective for postoperative analgesia but had a frequent rate of bacterial catheter colonization. We found no serious infections after short-term (2-day) infusion. Side effects were few, but one nerve injury occurred.

Cited by 272 publications

References 11 publications

Periarticular Injection in Knee Arthroplasty Improves Quadriceps Function

Periarticular Injection in Knee Arthroplasty Improves Quadriceps Function

Continuous peripheral nerve blocks for postoperative analgesia in children: feasibility and side effects in a cohort study of 339 catheters

Liposome Bupivacaine Femoral Nerve Block for Postsurgical Analgesia after Total Knee Arthroplasty

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