Anna M Bombardieri1,2, Daniel B Maalouf3, Richard L Kahn3, Yan Ma4, James J Bae3, Barbara Wukovits3, Andrew Lee3, Kethy M Jules-Elysee3, A Raffaele De Gaudio5, Gregory A Liguori3. 1. Department of Anesthesiology, Hospital for Special Surgery, New York, NY, USA - bombardieri.am@gmail.com. 2. Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA - bombardieri.am@gmail.com. 3. Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA. 4. Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA. 5. Section of Anesthesiology, Intensive Care and Pain Therapy, Department of Health Sciences, University of Florence, Florence, Italy.
Abstract
BACKGROUND: Continuous popliteal nerve block is utilized for postoperative analgesia after foot and ankle surgery. Whether only the total dose of local anesthetic or the combination of concentration and volume determine the characteristics of a continuous popliteal nerve infusion remains currently unknown. We hypothesized a reduction of the incidence of insensate extremity in patients givenropivacaine 0.4% at 4 mL/h compared to patients givenropivacaine 0.2% at 8 mL/h. METHODS:Sixty-four patients scheduled for major foot and ankle surgery requiring acontinuous popliteal catheter infusion for postoperative analgesia were studied. Thirty-three patients were randomized to receive a continuous popliteal nerve block with 0.2% (basal 8 mL/h) and thirty-one with 0.4% (basal 4 mL/h) ropivacaine, reaching the same total dose (16 mg/h). The primary outcome was the incidence of persistent sensory block in the distal sciatic nerve distributions in the postoperative period. Secondary outcomes were the incidence of motor block, NRS pain scores at rest in the postoperative period up to 48 hours after surgery, opioid use and related side effects, patients' satisfaction. RESULTS: The incidence of persistent sensory block was similar in patients given 0.2% and in patients receiving 0.4% ropivacaine. The incidence of motor block, postoperative pain scores at rest, use of oral opioids, side effects and patients' satisfaction with the quality of recovery were also similar in both groups. CONCLUSIONS: Our results suggest that local anesthetic total dose is the primary determinant of continuous popliteal perineural infusion effects.
RCT Entities:
BACKGROUND:Continuous popliteal nerve block is utilized for postoperative analgesia after foot and ankle surgery. Whether only the total dose of local anesthetic or the combination of concentration and volume determine the characteristics of a continuous popliteal nerve infusion remains currently unknown. We hypothesized a reduction of the incidence of insensate extremity in patients given ropivacaine 0.4% at 4 mL/h compared to patients given ropivacaine 0.2% at 8 mL/h. METHODS: Sixty-four patients scheduled for major foot and ankle surgery requiring a continuous popliteal catheter infusion for postoperative analgesia were studied. Thirty-three patients were randomized to receive a continuous popliteal nerve block with 0.2% (basal 8 mL/h) and thirty-one with 0.4% (basal 4 mL/h) ropivacaine, reaching the same total dose (16 mg/h). The primary outcome was the incidence of persistent sensory block in the distal sciatic nerve distributions in the postoperative period. Secondary outcomes were the incidence of motor block, NRS pain scores at rest in the postoperative period up to 48 hours after surgery, opioid use and related side effects, patients' satisfaction. RESULTS: The incidence of persistent sensory block was similar in patients given 0.2% and in patients receiving 0.4% ropivacaine. The incidence of motor block, postoperative pain scores at rest, use of oral opioids, side effects and patients' satisfaction with the quality of recovery were also similar in both groups. CONCLUSIONS: Our results suggest that local anesthetic total dose is the primary determinant of continuous popliteal perineural infusion effects.
Authors: Margaretha B Breebaart; Jordi Branders; Luc Sermeus; Sultan Termurziev; Helene Camerlynck; Lennert Van Putte; Marnik Van Putte Minelli; Stefan De Hert Journal: Local Reg Anesth Date: 2021-03-25