BACKGROUND: Efficacy of continuous perineural and patient-controlled ropivacaine infusion at home after orthopedic surgery was compared with patient-controlled intravenous morphine for functional recovery and postoperative analgesia in a multicenter randomized trial. METHODS:Eighty-three patients scheduled to undergo acromioplasty or hallux valgus surgery received an interscalene (n = 40) or popliteal (n = 43) peripheral nerve block with 30 ml ropivacaine, 0.5%. After randomization, patients were discharged home 24 h after surgery with a disposable infusion pump delivering either patient-controlled intravenous morphine (n = 23) or perineural 0.2% ropivacaine infusion, either continuous infusion without bolus (n = 30) or basal infusion plus bolus (n = 30). The patients recorded pain scores on movement and/or walking and were directed to take paracetamol and rescue analgesics if necessary. The time necessary to be able to walk for 10 min; daily activities on days 1, 2, and 3; adverse events; and overall satisfaction scores were noted and graded by the patient. RESULTS: Basal-bolus ropivacaine decreased the time to 10 minutes' walk, optimized daily activities (P < 0.01), and decreased the amount of ropivacaine used. The morphine group had greater pain scores and consumption of morphine and ketoprofen compared with both ropivacaine groups (P < 0.05). The incidence of nausea/vomiting, sleep disturbance, and dizziness increased, and the patient satisfaction score decreased in the morphine group (P < 0.05). CONCLUSIONS:After ambulatory orthopedic surgery, 0.2% ropivacaine delivered as a perineural infusion using a disposable elastomeric pump with patient-controlled anesthesia bolus doses optimizes functional recovery and pain relief while decreasing the consumption of rescue analgesics and ropivacaine, and the number of adverse events.
RCT Entities:
BACKGROUND: Efficacy of continuous perineural and patient-controlled ropivacaine infusion at home after orthopedic surgery was compared with patient-controlled intravenous morphine for functional recovery and postoperative analgesia in a multicenter randomized trial. METHODS: Eighty-three patients scheduled to undergo acromioplasty or hallux valgus surgery received an interscalene (n = 40) or popliteal (n = 43) peripheral nerve block with 30 ml ropivacaine, 0.5%. After randomization, patients were discharged home 24 h after surgery with a disposable infusion pump delivering either patient-controlled intravenous morphine (n = 23) or perineural 0.2% ropivacaine infusion, either continuous infusion without bolus (n = 30) or basal infusion plus bolus (n = 30). The patients recorded pain scores on movement and/or walking and were directed to take paracetamol and rescue analgesics if necessary. The time necessary to be able to walk for 10 min; daily activities on days 1, 2, and 3; adverse events; and overall satisfaction scores were noted and graded by the patient. RESULTS: Basal-bolus ropivacaine decreased the time to 10 minutes' walk, optimized daily activities (P < 0.01), and decreased the amount of ropivacaine used. The morphine group had greater pain scores and consumption of morphine and ketoprofen compared with both ropivacaine groups (P < 0.05). The incidence of nausea/vomiting, sleep disturbance, and dizziness increased, and the patient satisfaction score decreased in the morphine group (P < 0.05). CONCLUSIONS: After ambulatory orthopedic surgery, 0.2% ropivacaine delivered as a perineural infusion using a disposable elastomeric pump with patient-controlled anesthesia bolus doses optimizes functional recovery and pain relief while decreasing the consumption of rescue analgesics and ropivacaine, and the number of adverse events.
Authors: Maria Bauer; Lu Wang; Olusegun K Onibonoje; Chad Parrett; Daniel I Sessler; Loran Mounir-Soliman; Sherif Zaky; Viktor Krebs; Leonard T Buller; Michael C Donohue; Jennifer E Stevens-Lapsley; Brian M Ilfeld Journal: Anesthesiology Date: 2012-03 Impact factor: 7.892
Authors: Linda T Le; Vanessa J Loland; Edward R Mariano; J C Gerancher; Anupama N Wadhwa; Elizabeth M Renehan; Daniel I Sessler; Jonathan J Shuster; Douglas W Theriaque; Rosalita C Maldonado; Brian M Ilfeld Journal: Reg Anesth Pain Med Date: 2008 Nov-Dec Impact factor: 6.288
Authors: Joseph M Neal; J C Gerancher; James R Hebl; Brian M Ilfeld; Colin J L McCartney; Carlo D Franco; Quinn H Hogan Journal: Reg Anesth Pain Med Date: 2009 Mar-Apr Impact factor: 6.288
Authors: Brian M Ilfeld; Linda T Le; Joanne Ramjohn; Vanessa J Loland; Anupama N Wadhwa; J C Gerancher; Elizabeth M Renehan; Daniel I Sessler; Jonathan J Shuster; Douglas W Theriaque; Rosalita C Maldonado; Edward R Mariano Journal: Anesth Analg Date: 2009-01 Impact factor: 5.108
Authors: Edward R Mariano; Robert Afra; Vanessa J Loland; Navparkash S Sandhu; Richard H Bellars; Michael L Bishop; Gloria S Cheng; Lynna P Choy; Rosalita C Maldonado; Brian M Ilfeld Journal: Anesth Analg Date: 2009-05 Impact factor: 5.108