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Sirivanasandha B, Sutthivaiyakit K, Kerdchan T, Poolsuppasit S, Tangwiwat S, Halilamien P. Adding a low-concentration sciatic nerve block to total knee arthroplasty in patients susceptible to the adverse effects of non-steroidal anti-inflammatory drugs (NSAIDs): a randomized controlled trial. BMC Anesthesiol 2021; 21:282. [PMID: 34773995 PMCID: PMC8590368 DOI: 10.1186/s12871-021-01491-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 10/27/2021] [Indexed: 11/25/2022] Open
Abstract
Background This study compared the effects of adductor canal blocks with those of a low concentration of popliteal-sciatic nerve block (SNB) and dexamethasone as an adjunctive technique for total knee arthroplasties (TKA) in patients susceptible to the adverse effects of NSAIDs. Methods A prospective, double-blinded, randomized controlled trial was performed in 50 patients susceptible to the adverse effects of NSAIDs undergoing unilateral TKAs. All patients received spinal anesthesia, adductor canal blocks, and periarticular infiltration. The 25 patients in the intervention group received SNB (0.125% bupivacaine [20 ml] and dexamethasone [5 mg]). Results The SNB group significantly had lower median resting pain scores at 6, 12, and 18 h: the control group, 1 (0–4.5), 3 (0–5), and 3 (2–5); the intervention group, 0 (0–0), 0 (0–3), and 1 (0–3); p-values, 0.012, 0.021, and 0.010, respectively. Movement-evoked pain scores at 6, 12, and 18 h were also lower: control group, 3 (0–5.5), 5 (2.5–6.5), and 7 (4–9); intervention group, 0 (0–1.5), 2 (0–4), and 3 (2–5); p-values, 0.019, 0.005, and 0.001, respectively. There were no differences in motor function. Moreover, the mean morphine consumption 24 h was also reduced in the SNB group: control group, 3.80 ± 2.48 mg; intervention group, 1.96 ± 2 mg; p-value, 0.005. Conclusion For patients susceptible to the adverse effects of NSAIDs, a low concentration of SNB and dexamethasone is an effective adjunctive technique for early postoperative pain control (especially on movement) following TKAs, without an increase in motor weakness. Trial registration ClinicalTrials.gov, NCT03486548, Registered 3 April 2018.
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Affiliation(s)
- Busara Sirivanasandha
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand.
| | - Kulwadee Sutthivaiyakit
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Thippatai Kerdchan
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Suppachai Poolsuppasit
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Suwimon Tangwiwat
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Pathom Halilamien
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand
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Abstract
Regional anaesthesia is very effective in alleviating pain due to trauma, and is also used to provide anaesthesia for trauma surgery. It has the advantage of producing localized but complete pain relief, whilst avoiding the side effects of systemic analgesics or anaesthetics. However, regional anaesthetic drugs and techniques have potentially life-threatening complications, which the practitioner must be able to manage. This article discusses the use of regional anaesthesia, and the benefits and disadvantages of specific regional techniques in various traumatic conditions.
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Affiliation(s)
- JM Elliot
- Department of Anaesthesia, Good Hope Hospital, Sutton Coldfield, UK
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Bleckner L, Solla C, Fileta BB, Howard R, Morales CE, Buckenmaier CC. Serum Free Ropivacaine Concentrations Among Patients Receiving Continuous Peripheral Nerve Block Catheters. Anesth Analg 2014; 118:225-9. [DOI: 10.1213/ane.0000000000000019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Park CK, Cho CK, Lee GG, Lee JH. Optimizing dose infusion of 0.125% bupivacaine for continuous femoral nerve block after total knee replacement. Korean J Anesthesiol 2010; 58:468-76. [PMID: 20532056 PMCID: PMC2881523 DOI: 10.4097/kjae.2010.58.5.468] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Revised: 01/06/2010] [Accepted: 03/19/2010] [Indexed: 11/10/2022] Open
Abstract
Background The optimal dose infusion of 0.125% bupivacaine via a femoral catheter after total knee replacement (TKR) has not been defined. This study examined various dose infusions of bupivacaine to determine the analgesic quality in patients receiving a continuous femoral nerve block (CFNB). Methods Patients were randomized to receive a single-injection femoral nerve block (SFNB) or CFNB performed with 20 ml of 0.125% bupivacaine, followed by a continuous infusion of 0.125% bupivacaine in four groups (n = 20 per group): 1) 0 ml/h (SFNB), 2) 2 ml/h, 3) 4 ml/h, and 4) 6 ml/h. The pain intensity at rest and on knee movement was assessed using a visual analog scale (VAS) for the first 2 postoperative days. The cumulative bolus use of IV patientcontrolled analgesia (PCA) with a morphine-ketorolac combination was evaluated. Results A lower cumulative bolus of IV PCA was noted in all CFNB groups compared to SFNB on postoperative days (PODs) 1 and 2, respectively (P < 0.05). Lower VAS scores at rest were observed in the 4 ml/h and 6 ml/h groups than in the SFNB group on PODs 1 and 2, respectively, but only on POD 2 in the 2 ml/h group (P < 0.05). Lower VAS scores on movement were noted in the 4 ml/h than the SFNB group on PODs 1 and 2, but only on POD 1 in 6 ml/h (P < 0.05). Conclusions The minimum effective infusion rate of 0.125% bupivacaine for CFNB after TKR appears to be 4 ml/h according to the VAS pain scores.
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Affiliation(s)
- Chang Kil Park
- Department of Anesthesiology and Pain Medicine, College of Medicine, Eulji University, Daejeon, Korea
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Segado Jiménez MI, Bayón Gago M, Arias Delgado J, Casas García ML, Domínguez Hervella F, López Pérez A, Izquierdo Gutiérrez C. [Efficacy of obturator and femoral cutaneous nerve blocks for postoperative analgesia in hip surgery]. ACTA ACUST UNITED AC 2010; 56:590-7. [PMID: 20151520 DOI: 10.1016/s0034-9356(09)70474-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The treatment of pain after surgery to repair a hip fracture is essential for an early start of rehabilitation and for reducing morbidity and mortality. Given that patients are elderly and have multiple medical conditions, local-regional analgesia can be an effective approach. Our aim was to compare the efficacy of obturator and femoral cutaneous nerve blocks and total intravenous analgesia in terms of level of patient satisfaction, complications, start of rehabilitation, and cost. PATIENTS AND METHODS Prospective study of 75 patients undergoing surgery to repair hip fractures. Patients were randomized to receive intravenous analgesia only, blockade of both nerves, or blockade of only the obturator nerve. In each group we recorded visual analog scale (VAS) pain scores, satisfaction with postoperative analgesia, time elapsed until start of rehabilitation, need for postoperative analgesics, side effects, and the cost of drugs. RESULTS Analgesia was significantly more effective in patients with nerve blocks than in those who received only intravenous analgesia (mean [SD] VAS scores, 2.6 [1.4] and 5.6 [0.7], respectively). Patients with nerve blocks also had a pain-free period of more than 24 hours (P < .001), needed fewer doses of supplementary analgesics or other drugs, had fewer side effects (P < .01), started rehabilitation earlier (32.6 [5.4] hours vs 45.7 [8.2] hours), generated less expenditure (2.6 Euros [1.5 Euros]/patient vs 7.0 Euros [0.4 Euros]/patient). The tested techniques had no complications. CONCLUSIONS The nerve blocks were effective, easy to perform, and safe. They afforded numerous advantages: extended period of postoperative analgesia, fast recovery, lower costs, and no complications.
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Affiliation(s)
- M I Segado Jiménez
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor y de Farmacia Hospitalaria, Complejo Hospitalario de Ourense.
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Kopp SL, Wynd KP, Horlocker TT, Hebl JR, Wilson JL. Regional Blockade in Patients with a History of a Seizure Disorder. Anesth Analg 2009; 109:272-8. [DOI: 10.1213/ane.0b013e3181a832da] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Imbelloni LE. Bloqueio do plexo lombar no compartimento do psoas para analgesia pós-operatória em cirurgias ortopédicas. ACTA ORTOPEDICA BRASILEIRA 2008. [DOI: 10.1590/s1413-78522008000300006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVOS: O plexo lombar foi localizado entre os músculos quadrado lombar e psoas maior. O objetivo deste estudo foi avaliar a eficácia da injeção única de bupivacaína 0,25% através do bloqueio do compartimento do psoas na analgesia pós-operatória em pacientes de cirurgias ortopédicas. MÉTODO: Quarenta pacientes receberam bloqueio do plexo lombar no compartimento do psoas através da localização com estimulador de nervos e injeção de bupivacaína a 0,25%. Avaliou-se a analgesia e a intensidade da dor às 4, 8, 12, 16, 20 e 24 horas após o término da cirurgia, assim como opióides de resgate. RESULTADOS: Os nervos ilioinguinal, genitofemoral, cutâneo femoral lateral, femoral e obturatório foram bloqueados em 90% dos pacientes. O bloqueio reduziu o regaste de opióides administrados, sendo que 52,5% dos pacientes não necessitaram de complementação analgésica, com duração de 24 horas. Não foram observados sinais e sintomas clínicos da toxicidade da bupivacaína, nem seqüelas associadas com o bloqueio dos nervos. CONCLUSÕES: Este estudo mostra que a injeção no espaço do compartimento do psoas é fácil de realizar com efetivo bloqueio dos cinco nervos. O bloqueio do plexo lombar no compartimento do psoas pode ser recomendado para o uso na analgesia pós-operatória após cirurgias ortopédicas.
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Affiliation(s)
- Luiz Eduardo Imbelloni
- Instituto de Anestesia Regional; Anestesiologista da Casa de Saúde Santa Maria; Clínica São Bernardo
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Connolly C, Coventry DM, Wildsmith JA. Double-blind comparison of ropivacaine 7.5 mg ml(-1) with bupivacaine 5 mg ml(-1) for sciatic nerve block. Br J Anaesth 2001; 86:674-7. [PMID: 11575344 DOI: 10.1093/bja/86.5.674] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Two groups of 12 patients had a sciatic nerve block performed with 20 ml of either ropivacaine 7.5 mg ml(-1) or bupivacaine 5 mg ml(-1). There was no statistically significant difference in the mean time to onset of complete anaesthesia of the foot or to first request for post-operative analgesia. The quality of the block was the same in each group. Although there was no statistically significant difference in the mean time to peak plasma concentrations the mean peak concentration of ropivacaine was significantly higher than that of bupivacaine. There were no signs of systemic local anaesthetic toxicity in any patient in either group.
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Affiliation(s)
- C Connolly
- Department of Anaesthesia, Ninewells Hospital and Medical School, Dundee, UK
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Gebhard RE, Berry J, Maggio WW, Gollas A, Chelly JE. The Successful Use of Regional Anesthesia to Prevent Involuntary Movements in a Patient Undergoing Awake Craniotomy. Anesth Analg 2000. [DOI: 10.1213/00000539-200011000-00034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Gebhard RE, Berry J, Maggio WW, Gollas A, Chelly JE. The successful use of regional anesthesia to prevent involuntary movements in a patient undergoing awake craniotomy. Anesth Analg 2000; 91:1230-1. [PMID: 11049914 DOI: 10.1097/00000539-200011000-00034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
IMPLICATIONS The authors demonstrate that the combination of single and continuous peripheral nerve blocks allows the control of involuntary movements in patients undergoing awake craniotomy.
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Affiliation(s)
- R E Gebhard
- Department of Anesthesiology, The University of Texas-Houston Medical School, Houston, Texas 77030-1503, USA
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Naux E, Pham-Dang C, Petitfaux F, Bodin J, Blanche E, Hauet P, Gouin F, Pinaud M. [Sciatic nerve block: an new lateral mediofemoral approach. The value of its combination with a "3 in 1" block for invasive surgery of the knee]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2000; 19:9-15. [PMID: 10751950 DOI: 10.1016/s0750-7658(00)00129-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To describe a new midfemoral lateral approach for the sciatic nerve block. Its combination with the "3 in 1" block was tested for postoperative analgesia following major surgery of the knee. STUDY DESIGN Descriptive, anatomical and clinical study prospective. PATIENTS After testing in four unembalmed corpses the new approach was applied to 42 ASA 1-2 patients, in combination with a continuous "3 in 1" block. METHODS The new approach was analysed for reliability of the surface landmarks (a line drawn from the posterior margin of the greater trochanter towards the knee and parallel to the femur) and block extent assessed on the foot. Its combination with the "3 in 1" block was evaluated with a visual analogue scale (VAS) scoring, for postoperative analgesia after total knee arthroplasty. RESULTS The sciatic nerve was located in less than 10 min. A block of the sciatic nerve was fully achieved in all patients. Its median duration was 16 h. The median VAS score at rest was 0 mm (sciatic bloc + continuous block "3 in 1"), but increased to 40 mm (block "3 in 1" alone). CONCLUSION The new lateral midfemoral sciatic block is easy to master. Combined with a continuous "3 in 1" block, it provides excellent analgesia during the early postoperative period after major surgery of the knee.
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Affiliation(s)
- E Naux
- Service d'anesthésie-réanimation chirurgicale, Hôtel-Dieu, Nantes, France
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Tarkkila P, Tuominen M, Huhtala J, Lindgren L. Comparison of intrathecal morphine and continuous femoral 3-in-1 block for pain after major knee surgery under spinal anaesthesia. Eur J Anaesthesiol 1998. [PMID: 9522133 DOI: 10.1097/00003643-199801000-00002] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Major knee surgery is associated with moderate or severe post-operative pain. Intrathecal morphine and continuous femoral 3-in-1 block were compared prospectively in 40 patients for pain after major knee surgery under spinal anaesthesia, with 4 mL isobaric 0.5% bupivacaine. In a random order, 20 patients received preservative free morphine 0.3 mg mixed with spinal bupivacaine. In 20 patients, following spinal anaesthesia with only bupivacaine, femoral 3-in-1 block was performed post-operatively with 0.5% bupivacaine 2 mg kg-1. The block was continued via a catheter with 0.25% bupivacaine 0.1 mL h-1 kg-1 until the next morning (24 h after induction of spinal anaesthesia). Intramuscular oxycodone was given as a rescue analgesic in all patients. Two patients from the femoral group were excluded due to technical failure. Three patients in the morphine group and one patient in the femoral group did not need any additional oxycodone. In the morphine group on average 2.8 (range 0-7) and in the femoral group 3.2 (0-5) additional doses of oxycodone were needed during the 24 h observation period. The mean pain scores were significantly lower in the morphine group at 9 and 12 h into the 24-h trial. Itching was seen only in the morphine group (40% of the patients). Other side effects were similar in the two groups. All patients were satisfied with their pain therapy. Both intrathecal morphine and femoral 3-in-1 block alone were insufficient for the treatment of severe pain after major knee surgery.
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Affiliation(s)
- P Tarkkila
- Department of Anaesthesia, Helsinki University Central Hospital, Finland
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Edkin BS, Spindler KP, Flanagan JF. Femoral nerve block as an alternative to parenteral narcotics for pain control after anterior cruciate ligament reconstruction. Arthroscopy 1995; 11:404-9. [PMID: 7575871 DOI: 10.1016/0749-8063(95)90191-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Anterior cruciate ligament (ACL) reconstruction is associated with significant postoperative pain, usually requiring parenteral narcotics. A prospective study of arthroscopically assisted autograft patellar tendon ACLR was initiated using Winnie's "three-in-one" femoral nerve block (FNB) as the primary means of postoperative pain control. Patient satisfaction and absence of parenteral narcotic use indicated clinical success. Of 24 patients studied, 92% had no parenteral narcotics administered following FNB. Ninety-five percent of patients believed FNB was beneficial and would request another. The average duration of pain control was 29 hours and the majority of patients (79%) believed discharge was possible within 23 hours. There were two patients who failed to respond to FNBs (8%) and no major complications. FNB is a safe, reliable, and effective form of analgesia following ACLR, eliminating the need for parenteral narcotics.
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Affiliation(s)
- B S Edkin
- Vanderbilt Sports Medicine Center, Nashville, TN 37212, USA
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Farny J, Girard M, Drolet P. Posterior approach to the lumbar plexus combined with a sciatic nerve block using lidocaine. Can J Anaesth 1994; 41:486-91. [PMID: 8069988 DOI: 10.1007/bf03011542] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
A combination of lumbar plexus block, by a posterior technique, and sciatic nerve block can be a useful technique for outpatient anaesthesia. The purpose of this study was to examine the clinical characteristics of these blocks using lidocaine and to measure the serum lidocaine concentrations. Forty-five patients, undergoing lower extremity surgery, were studied. Sciatic nerve and lumbar plexus blocks were made with lidocaine, 680 mg with adrenaline 0.3 mg. For each patient the following data were collected: weight, age, sex, site of surgery, time to perform each block, needle depth, speed of onset of the sensory and motor blocks in the territories of the sciatic, femoral, obturator and lateral cutaneous (sensory) nerves and postoperative analgesic requirements. Lidocaine serum concentrations were measured in ten of these patients at 0, 2, 5, 10, 30, 60, 90 and 120 min after the second block. Analgesia was complete in 88% (40/45) of the patients. The remaining five patients needed analgesics (fentanyl 150 micrograms or less). Despite the high dose of lidocaine, the serum concentrations were within safe limits (mean +/- SD) (CMAX = 3.66 +/- 2.21 micrograms.ml-1). Only one patient had a serum concentration > 5 micrograms.ml-1 (CMAX = 9.54 micrograms.ml-1). This was associated with a contra-lateral extension of the block. We conclude that this combination of blocks is a valuable alternative for unilateral lower extremity anaesthesia. However, clinicians must be aware of the implications of a contra-lateral extension of the block.
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