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Wu M, Barrak C, Forrest P, Rizzo D, Guerra-Londono CE. Assessment of catheter position using chest CT in adults undergoing erector spinae plane analgesia for rib fractures: a retrospective cohort study. Reg Anesth Pain Med 2024:rapm-2024-105673. [PMID: 38969508 DOI: 10.1136/rapm-2024-105673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 06/23/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND Continuous erector spinae plane (ESP) analgesia is a common adjuvant for patients with traumatic rib fracture pain and success relies on the ESP catheter remaining within the correct fascial plane for the duration of its placement. However, knowledge on postplacement position of indwelling ESP catheters is largely absent. We hypothesized that migration of over-the-needle ESP catheters was common and detectable with coincidental postprocedure CT. METHODS In this single-center retrospective cohort study, adults admitted to the surgical intensive care unit for traumatic rib fractures between January 2020 and July 2022 were screened. Those receiving continuous ESP analgesia via indwelling catheter and undergoing subsequent chest CT were included. The primary outcome was the proportion of catheters that migrated outside the ESP. The secondary outcome was the distance between the catheter tip and the nearest transverse process (TP) or fascial plane. RESULTS 160 medical records were screened for eligibility and 15 patients (18 catheters) met the inclusion criteria. 16 of 18 catheters reviewed were found outside the ESP. Furthermore, catheter position was reported as intramuscular in 14 catheters and subcutaneous in 4 catheters. The median distance between catheter tip and the nearest TP (or the ESP) was 23.20 mm sagittally and 25.05 mm axially. CONCLUSIONS Most ESP catheters were found superficial to the fascial plane in the days following their placement. The median distance between the catheter and the ESP is between 23 and 25 mm. Prospective studies should address catheter migration concerns and propose solutions to this common issue.
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Affiliation(s)
- Maylyn Wu
- Michigan State University College of Osteopathic Medicine, East Lansing, Michigan, USA
| | - Charbel Barrak
- Department of Anesthesiology, Pain Management, & Perioperative Medicine, Henry Ford Health System, Detroit, Michigan, USA
| | - Patrick Forrest
- Department of Anesthesiology, Pain Management, & Perioperative Medicine, Henry Ford Health System, Detroit, Michigan, USA
| | - Derek Rizzo
- Department of Anesthesiology, Pain Management, & Perioperative Medicine, Henry Ford Health System, Detroit, Michigan, USA
| | - Carlos Eduardo Guerra-Londono
- Department of Anesthesiology, Pain Management, & Perioperative Medicine, Henry Ford Health System, Detroit, Michigan, USA
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2
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Goffin P, Morales L, Jorcano E, Prats-Galino A, Reina MA, Sala-Blanch X. Dislodgment of continuous suprascapular nerve block catheters after physiotherapy: A cadaver study. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024; 71:291-297. [PMID: 38431047 DOI: 10.1016/j.redare.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/28/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND Continuous peripheral nerve blocks are commonly used for pain management. However, the incidence of catheter dislodgement or migration is unclear, and may be underestimated and underreported. Our objective was to assess suprascapular catheter tip positioning before and after routine simulated shoulder physiotherapy manipulation in an anatomical cadaver model. METHOD Eight ultrasound-guided continuous suprascapular nerve block catheters were placed in cryopreserved fresh cadavers. Computed tomography (CT) confirmed the location of the catheter tip after injection of 1 ml of contrast medium. We performed a series of standardized shoulder movements during a simulated shoulder physiotherapy session in cadavers. Following this, we administered 1 ml of methylene blue through the catheters, and then performed anatomical dissections to accurately identify the location of the catheter tips and compare them to their placement prior to the 'physiotherapy'. RESULT CT imaging confirmed the location of the catheter tips at the suprascapular notch in all cases. However, following physiotherapy, 2 catheters (25%) were found to have migrated - specifically, 1 was located in the supraspinatus muscle, and the other was located in the trapezius muscle. CONCLUSION Our findings suggest that catheter dislodgement may occur in approximately 25% of cases following simulated physiotherapy manipulation. However, further research is needed to determine the read incidence of catheter dislodgement in clinical practice.
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Affiliation(s)
- P Goffin
- Master's Degree in Advanced Medical Competencies, Regional Anesthesia Based on Human Anatomy, University of Barcelona, Barcelona, Spain; Department of Anesthesia, MontLegia Hospital, CHC Groupe Santé, Liège, Belgium.
| | - L Morales
- Master in Advanced Medical Skills in Regional Anesthesia based in Anatomy, University of Barcelona, Barcelona, Spain
| | - E Jorcano
- Department of Radiology, Hospital ClÍnic, Barcelona, Spain
| | - A Prats-Galino
- Human Anatomy and Embryology, University of Barcelona, Barcelona, Spain
| | - M A Reina
- CEU-San-Pablo University School of Medicine, Madrid, and Madrid-Montepríncipe University Hospital, Madrid, Spain; Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United States
| | - X Sala-Blanch
- Human Anatomy and Embryology, University of Barcelona, Barcelona, Spain; Department of Anesthesia, Hospital Clínic, Barcelona, Spain
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Saranteas T, Poulogiannopoulou E, Ntalamagka G, Skaligkou P, Giasafaki M, Papadimos T. Perineural coiled echogenic catheters with a flexible distal end: A brief technical report. Anaesth Crit Care Pain Med 2024; 43:101341. [PMID: 38142867 DOI: 10.1016/j.accpm.2023.101341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/30/2023] [Accepted: 12/11/2023] [Indexed: 12/26/2023]
Affiliation(s)
- Theodosios Saranteas
- Second Department of Anaesthesiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Poulogiannopoulou
- Second Department of Anaesthesiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| | - Georgia Ntalamagka
- Second Department of Anaesthesiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Pagona Skaligkou
- Second Department of Anaesthesiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Marianna Giasafaki
- Second Department of Anaesthesiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Thomas Papadimos
- Department of Anaesthesiology, College of Medicine and Life Sciences, University of Toledo, OH, USA
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Hannig KE, Hauritz RW, Bjørn S, Jensen HI, Henriksen CW, Jessen C, Bendtsen TF. Pain relief after major ankle and hindfoot surgery with repetitive peripheral nerve blocks: A feasibility study. Acta Anaesthesiol Scand 2023; 67:1266-1272. [PMID: 37280182 DOI: 10.1111/aas.14289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/12/2023] [Accepted: 05/23/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Major ankle and hindfoot surgery (e.g., ankle, triple and subtalar arthrodesis) typically causes severe postoperative pain, especially the first two postoperative days. Current modalities of postoperative analgesic treatment often include continuous peripheral nerve blocks of the saphenous and sciatic nerves via catheters in order to extend the duration of pain- and opioid-free nerve blockade to 48 h. Unfortunately, the 48 h-efficacy of continuous infusion via a catheter is reduced by a high displacement rate. We hypothesised that one-time repetition of the single injection peripheral nerve blocks would provide effective analgesia with a low opioid consumption the first 48 postoperative hours. METHODS Eleven subjects preoperatively received a popliteal sciatic and a saphenous single injection nerve block with a protracted local anaesthetic mixture. Surgery was performed under general anaesthesia. The one-time repetition of the single injection nerve block was carried out approximately 24 h after the primary nerve block. The main outcomes were pain and cumulative opioid consumption during the first 48 postoperative hours. RESULTS Nine of the 11 (82%) patients had effective analgesia without opioids during the first 48 postoperative hours. Two patients each required a single dose of 7.5 mg of oral morphine equivalents after 43 h. CONCLUSION One-time repetition of single injection saphenous and sciatic nerve blocks consistently provided effective analgesia practically without opioids for 48 h after major elective ankle and hindfoot surgery.
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Affiliation(s)
- Kjartan E Hannig
- Department of Anaesthesiology, Kolding Hospital, a part of Lillebaelt Hospital, University Hospital of Southern Denmark, Denmark
- Department of Anaesthesiology, Vejle Hospital, a part of Lillebaelt Hospital, University Hospital of Southern Denmark, Denmark
| | - Rasmus W Hauritz
- Department of Anaesthesiology, Kolding Hospital, a part of Lillebaelt Hospital, University Hospital of Southern Denmark, Denmark
| | - Siska Bjørn
- Institute of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
| | - Hanne Irene Jensen
- Department of Anaesthesiology, Kolding Hospital, a part of Lillebaelt Hospital, University Hospital of Southern Denmark, Denmark
- Department of Anaesthesiology, Vejle Hospital, a part of Lillebaelt Hospital, University Hospital of Southern Denmark, Denmark
| | - Claus W Henriksen
- Department of Orthopaedic Surgery, Kolding Hospital, a part of Lillebaelt Hospital, University Hospital of Southern Denmark, Denmark
| | | | - Thomas F Bendtsen
- Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark
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Fujino T, Yoshida T, Kawagoe I, Hinotsume A, Hiratsuka T, Nakamoto T. Migration rate of proximal adductor canal block catheters placed parallel versus perpendicular to the nerve after total knee arthroplasty: a randomized controlled study. Reg Anesth Pain Med 2023; 48:420-424. [PMID: 36977526 PMCID: PMC10359574 DOI: 10.1136/rapm-2022-104303] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/16/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Perineural catheters placed parallel to the nerve course are reported to have lower migration rates than those placed perpendicular to it. However, catheter migration rates for a continuous adductor canal block (ACB) remain unknown. This study compared postoperative migration rates of proximal ACB catheters placed parallel and perpendicular to the saphenous nerve. METHODS Seventy participants scheduled for unilateral primary total knee arthroplasty were randomly assigned for parallel or perpendicular placement of the ACB catheter. The primary outcome was the migration rate of the ACB catheter on postoperative day (POD) 2. Catheter migration was defined as being unable to confirm saline administration via the catheter around the saphenous nerve at the mid-thigh level under ultrasound guidance. Secondary outcomes included active and passive range of motion (ROM) of the knee on postoperative rehabilitation. RESULTS Sixty-seven participants were included in the final analyses. The catheter migrated significantly less often in the parallel group (5 of 34 (14.7%)) than in the perpendicular group (24 of 33 (72.7%)) (p<0.001). The mean (SD) active and passive knee flexion ROM (degrees) improved significantly in the parallel than in the perpendicular group (POD 1: active, 88.4 (13.2) vs 80.0 (12.4), p=0.011; passive, 95.6 (12.8) vs 85.7 (13.6), p=0.004; POD 2: active, 88.7 (13.4) vs 82.2 (11.5), p=0.036; passive, 97.2 (12.8) vs 91.0 (12.0), p=0.045). CONCLUSION Parallel placement of the ACB catheter provided a lower postoperative catheter migration rate than perpendicular placement of the ACB catheter along with corresponding improvements in ROM and secondary analgesic outcomes. TRIAL REGISTRATION NUMBER UMIN000045374.
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Affiliation(s)
- Takashi Fujino
- Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Anesthesiology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Takayuki Yoshida
- Department of Anesthesiology and Pain Management, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Department of Anesthesiology, Kansai Medical University Medical Center, Moriguchi, Osaka, Japan
| | - Izumi Kawagoe
- Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Akinori Hinotsume
- Department of Anesthesiology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Tsuyoshi Hiratsuka
- Department of Anesthesiology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Tatsuo Nakamoto
- Department of Anesthesiology, Kansai Medical University, Hirakata, Osaka, Japan
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Milto AJ, Negri CE, Baker J, Thuppal S. The Statistical Fragility of Foot and Ankle Surgery Randomized Controlled Trials. J Foot Ankle Surg 2022; 62:191-196. [PMID: 36182644 DOI: 10.1053/j.jfas.2022.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/16/2022] [Accepted: 08/27/2022] [Indexed: 02/03/2023]
Abstract
Fragility index (FI) is a metric used to interpret the results of randomized controlled trials (RCTs), and describes the number of subjects that would need to be switched from event to non-event for a result to no longer be significant. Studies that analyze FI of RCTs in various orthopedic subspecialties have shown the RCTs to be largely underpowered and highly fragile. However, FI has not been assessed in foot and ankle RCTs. The MEDLINE and Embase online databases were searched from 1/1/2011 through 11/19/2021 for RCTs involving foot and ankle conditions. FI, fragility quotient (FQ), and difference between the FI and number of subjects lost to follow-up was calculated. Spearman correlation was performed to determine the relationship between sample size and FI. Overall, 1262 studies were identified of which 18 were included in the final analysis. The median sample size was 65 (interquartile range [IQR] 57-95.5), the median FI was 2 (IQR 1-2.5), and the median FQ was 0.026 (IQR 0.012-0.033). Ten of 15 (67%) studies with non-zero FI values had FI values less than the number of subjects lost to follow-up. There was linear association between FI and sample size (R2 = 0.495, p-value: .031). This study demonstrates that RCTs in the field of foot and ankle surgery are highly fragile, similar to other orthopedic subspecialties.
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Affiliation(s)
- Anthony J Milto
- Division of Orthopedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL; Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, IL
| | - Cecily E Negri
- Division of Orthopedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL
| | - Jeffrey Baker
- Division of Orthopedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL
| | - Sowmyanarayanan Thuppal
- Division of Orthopedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL; Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, IL.
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7
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Nickl R, Vicent O, Müller T, Osmers A, Schubert K, Koch T, Richter T. Impact of self-coiling catheters for continuous popliteal sciatic block on postoperative pain level and dislocation rate: a randomized controlled trial. BMC Anesthesiol 2022; 22:159. [PMID: 35610566 PMCID: PMC9128226 DOI: 10.1186/s12871-022-01700-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 05/19/2022] [Indexed: 11/30/2022] Open
Abstract
Background Dislocation of catheters within the tissue is a challenge in continuous regional anesthesia. A novel self-coiling catheter design is available and has demonstrated a lower dislocation rate in a cadaver model. The dislocation rate and effect on postoperative pain of these catheters in vivo has yet to be determined and were the subjects of this investigation. Methods After ethics committee approval 140 patients undergoing elective distal lower limb surgery were enrolled in this prospective randomized controlled trial. Preoperatively, patients were randomly assigned and received either the conventional (n = 70) or self-coiling catheter (n = 70) for ultrasound-guided popliteal sciatic nerve block in short axis view and by the in-plane approach from lateral to medial. The primary outcome was pain intensity after surgery and on the following three postoperative days. Secondary outcomes investigated were dislocation rate in situ determined by sonography, catheter movement visible from outside, opioid consumption as well as leakage at the puncture site. Results All catheters were successfully inserted. The study population of self-coiling catheters had significantly lower mean numeric rating scale values than the reference cohort on the first (p = 0.01) and second postoperative days (p < 0.01). Sonographic evaluation demonstrated, 42 standard catheters (60%) and 10 self-coiling catheters (14.3%) were dislocated in situ within the first three postoperative days. The externally visible movement of the catheters at insertion site did not differ significantly between groups through the third postoperative day. The opioid consumption was significantly lower in the self-coiling catheter group on the day of surgery and on the second and third postoperative days (p = 0.04, p = 0.03 and p = 0.04, respectively). Conclusion The self-coiling catheter offers a better postoperative pain control and a lower dislocation rate within the tissue when blocking the popliteal sciatic nerve compared to a conventional catheter. Further trials in large patient cohorts are warranted to investigate the potential beneficial effects of self-coiling catheters for other localisations and other application techniques. Trial registration The trial was registered at German Clinical Trials Register (DRKS) on 08/04/2020 (DRKS00020938, retrospectively registered).
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Affiliation(s)
- Rosa Nickl
- Department of Anesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstr 74, 01307, Dresden, Germany.
| | - Oliver Vicent
- Department of Anesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstr 74, 01307, Dresden, Germany
| | - Thomas Müller
- Department of Anesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstr 74, 01307, Dresden, Germany
| | - Anne Osmers
- Department of Anesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstr 74, 01307, Dresden, Germany
| | - Konrad Schubert
- Institute for Medical Informatics and Biometry, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Fetscherstr 74, 01307, Dresden, Germany
| | - Thea Koch
- Department of Anesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstr 74, 01307, Dresden, Germany
| | - Torsten Richter
- Department of Anesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstr 74, 01307, Dresden, Germany
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8
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Osterc T, Rupnik B, Rosskopf AB, Borgeat A, Eichenberger U, Aguirre J. Inadvertent Placement of an Infraclavicular Catheter in the Interscalene Region With an Unusual Complication: A Case Report. A A Pract 2022; 16:e01572. [DOI: 10.1213/xaa.0000000000001572] [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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9
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Tuyakov B, Kruszewski M, Glinka L, Klonowska O, Borys M, Piwowarczyk P, Onichimowski D. Incidence of Suture-Method Catheter Dislocation with Femoral Nerve Block and Femoral Triangle Block after Total Knee Arthroplasty. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136687. [PMID: 34206188 PMCID: PMC8297104 DOI: 10.3390/ijerph18136687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/18/2021] [Accepted: 06/20/2021] [Indexed: 11/16/2022]
Abstract
Catheter dislocation with continuous peripheral nerve blocks represents a major problem in clinical settings. There is a range of factors affecting the incidence of catheter dislocation, including catheter type. This study aimed to assess the incidence of suture-method catheter (SMC) dislocation 24 h after total knee arthroplasty (TKA), with continuous femoral nerve block (CFNB) and continuous femoral triangle block (CFTB), respectively. In the prospective randomized trial, 40 patients qualified for TKA with SMC and were divided into two groups, those who received CFNB (Group 1, n = 20) and those who received CFTB (Group 2, n = 20). After 24 h, the degree of catheter displacement (cm), pain intensity (NRS) and opioid consumption (mg) was assessed. The catheter dislocation rates were found to be 15% in Group 1 versus 5% in Group 2, with the catheter dislocated by 0.83 cm (SD = ±0.87) and 0.43 cm (SD = ±0.67), respectively. There were no differences in NRS score (p = 0.86) or opioid consumption (p = 0.16) between the groups. In each case, a displaced catheter was successfully repositioned by pulling, which clinically resulted in a lower NRS score. The results of the study suggest that CFTB with SMC may be used after TKA with a good effect, as it is associated with low catheter dislocation rates and an adequate analgesic effect.
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Affiliation(s)
- Bulat Tuyakov
- Department of Anesthesiology and Intensive Care, Regional Specialist Teaching Hospital, 10-719 Olsztyn, Poland; (M.K.); (D.O.)
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, University of Warmia and Mazury, 10-719 Olsztyn, Poland;
- Correspondence: ; Tel.: +48-606380943
| | - Mateusz Kruszewski
- Department of Anesthesiology and Intensive Care, Regional Specialist Teaching Hospital, 10-719 Olsztyn, Poland; (M.K.); (D.O.)
| | - Lidia Glinka
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, University of Warmia and Mazury, 10-719 Olsztyn, Poland;
- Department of Anaesthesiology and Intensive Care, Teaching University Hospital, 10-082 Olsztyn, Poland
| | - Oksana Klonowska
- Department of Anatomy, Faculty of Medicine, University of Warmia and Mazury, 10-719 Olsztyn, Poland;
| | - Michal Borys
- 2nd Department of Anesthesiology and Intensive Care, Medical University of Lublin, 20-081 Lublin, Poland; (M.B.); (P.P.)
| | - Pawel Piwowarczyk
- 2nd Department of Anesthesiology and Intensive Care, Medical University of Lublin, 20-081 Lublin, Poland; (M.B.); (P.P.)
| | - Dariusz Onichimowski
- Department of Anesthesiology and Intensive Care, Regional Specialist Teaching Hospital, 10-719 Olsztyn, Poland; (M.K.); (D.O.)
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, University of Warmia and Mazury, 10-719 Olsztyn, Poland;
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10
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Breebaart MB, Branders J, Sermeus L, Termurziev S, Camerlynck H, Van Putte L, Van Putte Minelli M, De Hert S. Levobupivacaine Consumption in Automated Intermittent Bolus in Ultrasound Guided Subparaneural Sciatic Nerve Catheters: A Prospective Double-Blind Randomized Trial. Local Reg Anesth 2021; 14:43-50. [PMID: 33790643 PMCID: PMC8007557 DOI: 10.2147/lra.s299870] [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: 12/31/2020] [Accepted: 03/03/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Continuous sciatic nerve blocks have proven benefits for postoperative analgesia after foot surgery. However, the optimal mode of administration remains a point of debate. Ultrasound guided subparaneural injection accelerates onset time and increases duration after a single shot sciatic nerve block. This double blind prospective randomized trial compares the 48-hour local anesthetic (LA) dose consumption of an automated intermittent bolus technique to a continuous infusion regimen in a subparaneural sciatic nerve catheter after hallux valgus surgery. Patients and Methods Patients scheduled for hallux valgus surgery were randomized to receive either a continuous infusion of levobupivacaine 0.125% at 5mL/h (group A) or an intermittent automated bolus of 9.8 mL every 2 hours with a background of 0.1 mL/h (group B), both with a PCA bolus of 6 mL and lockout of 30 minutes. The 48 hour LA consumption, PCA boluses, Numeric Rating Scale (NRS), satisfaction and return of normal sensation were recorded. Results Sixteen patients were excluded because of protocol violation or technical problems and 42 patients remained for analysis. The 48 hour ropivacaine consumption was higher in group A (293 ±60 mL) than group B (257±33 mL). The median and highest NRS scores and patient satisfaction were not statistically different between groups. Normal sensation returned after 75 ± 22 hours (group A) and 70 ± 17 hours (group B). Conclusion Programmed bolus administration in subparaneural sciatic nerve catheters reduces LA consumption 48 hours after surgery with equal analgesia and patient satisfaction. Return of sensation is variable and can last more than 75 hours.
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Affiliation(s)
- Margaretha B Breebaart
- Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium.,Department of Anesthesia, Antwerp University Hospital, Edegem, Belgium
| | - Jordi Branders
- Department of Anesthesia, Antwerp University Hospital, Edegem, Belgium
| | - Luc Sermeus
- Department of Anesthesiology, St. Luc University Hospital, Brussels, Belgium
| | - Sultan Termurziev
- Department of Anesthesia, Antwerp University Hospital, Edegem, Belgium
| | - Helene Camerlynck
- Department of Anesthesia, Antwerp University Hospital, Edegem, Belgium
| | - Lennert Van Putte
- Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
| | | | - Stefan De Hert
- Department of Anesthesia and Perioperative Medicine, Ghent University Hospital, Ghent, Belgium
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11
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Affiliation(s)
- S. Shevlin
- Belfast Health and Social Care Trust, Belfast, UK
| | - D. Johnston
- Belfast Health and Social Care Trust, Belfast, UK
| | - L. Turbitt
- Belfast Health and Social Care Trust, Belfast, UK
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12
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Dislocation rates of perineural catheters placed either perpendicular or parallel to the femoral nerve. Eur J Anaesthesiol 2020; 37:758-764. [DOI: 10.1097/eja.0000000000001237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Suture-method versus Through-the-needle Catheters for Continuous Popliteal-sciatic Nerve Blocks. Anesthesiology 2020; 132:854-866. [DOI: 10.1097/aln.0000000000003145] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Abstract
Background
The basic perineural catheter design has changed minimally since inception, with the catheter introduced through or over a straight needle. The U.S. Food and Drug Administration recently cleared a novel perineural catheter design comprising a catheter attached to the back of a suture-shaped needle that is inserted, advanced along the arc of its curvature pulling the catheter past the target nerve, and then exited through the skin in a second location. The authors hypothesized that analgesia would be noninferior using the new versus traditional catheter design in the first two days after painful foot/ankle surgery with a primary outcome of average pain measured with the Numeric Rating Scale.
Methods
Subjects undergoing painful foot or ankle surgery with a continuous supraparaneural popliteal-sciatic nerve block 5 cm proximal to the bifurcation were randomized to either a suture-type or through-the-needle catheter and subsequent 3-day 0.2% ropivacaine infusion (basal 6 ml/h, bolus 4 ml, lockout 30 min). Subjects received daily follow-up for the first four days after surgery, including assessment for evidence of malfunction or dislodgement of the catheters.
Results
During the first two postoperative days the mean ± SD average pain scores were lower in subjects with the suture-catheter (n = 35) compared with the through-the-needle (n = 35) group (2.7 ± 2.4 vs. 3.4 ± 2.4) and found to be statistically noninferior (95% CI, −1.9 to 0.6; P < 0.001). No suture-style catheter was completely dislodged (0%), whereas the tips of three (9%) traditional catheters were found outside of the skin before purposeful removal on postoperative day 3 (P = 0.239).
Conclusions
Suture-type perineural catheters provided noninferior analgesia compared with traditional catheters for continuous popliteal-sciatic blocks after painful foot and ankle surgery. The new catheter design appears to be a viable alternative to traditional designs used for the past seven decades.
Editor’s Perspective
What We Already Know about This Topic
What This Article Tells Us That Is New
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14
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Lyngeraa TS, Jæger P, Gottschau B, Graungaard B, Rossen‐Jørgensen AM, Toftegaard I, Grevstad U. Comparison of the analgesic effect of an adductor canal block using a new suture‐method catheter vs. standard perineural catheter vs. single‐injection: a randomised, blinded, controlled study. Anaesthesia 2019; 74:1397-1405. [DOI: 10.1111/anae.14814] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2019] [Indexed: 11/30/2022]
Affiliation(s)
- T. S. Lyngeraa
- Department of Anaesthesia and Intensive Care Medicine Copenhagen University Hospital Nordsjællands Hospital Hillerød Denmark
| | - P. Jæger
- Department of Anaesthesia, Centre of Head and Orthopaedics Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - B. Gottschau
- Department of Anaesthesia and Intensive Care Medicine Copenhagen University Hospital Gentofte Hospital Gentofte Denmark
| | - B. Graungaard
- Department of Anaesthesia and Intensive Care Medicine Copenhagen University Hospital Gentofte Hospital Gentofte Denmark
| | - A. M. Rossen‐Jørgensen
- Department of Anaesthesia and Intensive Care Medicine Copenhagen University Hospital Gentofte Hospital Gentofte Denmark
| | - I. Toftegaard
- Department of Anaesthesia and Intensive Care Medicine Copenhagen University Hospital Gentofte Hospital Gentofte Denmark
| | - U. Grevstad
- Department of Anaesthesia and Intensive Care Medicine Copenhagen University Hospital Gentofte Hospital Gentofte Denmark
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Hauritz RW, Hannig KE, Balocco AL, Peeters G, Hadzic A, Børglum J, Bendtsen TF. Peripheral nerve catheters: A critical review of the efficacy. Best Pract Res Clin Anaesthesiol 2019; 33:325-339. [PMID: 31785718 DOI: 10.1016/j.bpa.2019.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 07/11/2019] [Indexed: 10/26/2022]
Abstract
Continuous peripheral nerve blocks are commonly used for postoperative analgesia after surgery. However, catheter failure may occur due to either primary (incorrect insertion) or secondary reasons (displacement, obstruction, disconnection). Catheter failure results in unanticipated pain, need for opioid use, and risk of readmission or delay in hospital discharge. This review aimed to assess definition and frequency of catheter failure, and discuss the alternatives to prolong duration of single-shot nerve blocks. A literature search was performed on peripheral catheters reporting failure as the main outcome measure. Thirty-three studies met the selection criteria, comprising 2711 catheters. Literature review suggests that peripheral nerve catheters have clinically significant failure rate when the assessment is performed using an objective (imaging) method. Subjective methods of assessment (without imaging) may underestimate the incidence of catheter failure.
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Affiliation(s)
- Rasmus W Hauritz
- Department of Anesthesia and Intensive Care Medicine, Kolding Hospital, Denmark
| | - Kjartan E Hannig
- Department of Anesthesia and Intensive Care Medicine, Kolding Hospital, Denmark
| | - Angela Lucia Balocco
- Department of Anesthesiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.
| | - Gwendolyne Peeters
- Department of Anesthesiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.
| | - Admir Hadzic
- Department of Anesthesiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.
| | - Jens Børglum
- Department of Anesthesia and Intensive Care Medicine, Zealand University Hospital, Denmark
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16
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Lyngeraa TS, Rothe C, Grevstad U, Lundstrøm LH, Lange KHW. Adductor canal block with a suture-method catheter - A parallel or perpendicular approach? Acta Anaesthesiol Scand 2019; 63:523-530. [PMID: 30520017 DOI: 10.1111/aas.13300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 10/05/2018] [Accepted: 10/15/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND We performed a randomised blinded pilot study in 16 healthy volunteers to assess whether placing a suture-method catheter in the adductor canal is feasible with two different insertion techniques. METHODS Each volunteer had a suture-method catheter placed approximately halfway between the superior anterior iliac spine and base of the patella in both legs. Catheters were placed using a parallel technique in one leg and a perpendicular technique in the other leg, according to randomisation. 15 mL lidocaine 1% was injected in each catheter. Successful placement was defined as loss of cold sensation in the saphenous area 30 min after injection. Volunteers were sent home and returned the following day and another dose of lidocaine (15 mL, 1%) was injected through the catheters. Catheter displacement distance was assessed by ultrasound and cold sensation was assessed. In case of preserved cold sensation, we attempted to reposition the catheter with a subsequent injection of lidocaine and reassessment of cold sensation. RESULTS All primary placements were successful using the perpendicular approach (100%; 95% CI 81%-100%) whereas one placement failed using the parallel approach (94%; 95% CI 72%-99%). Three catheters placed using the perpendicular approach were displaced on day 2, compared to one catheter placed with the parallel approach. Displacement distance was highly variable. All catheters, except one, could be repositioned. Three volunteers reported transient sensory deficits lasting approximately 6-8 weeks. CONCLUSION The suture-method catheter can be placed in the adductor canal with high success rates for initial placement with both techniques.
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Affiliation(s)
- Tobias S. Lyngeraa
- Department of Anaesthesia and Intensive Care Medicine; Copenhagen University Hospital; Nordsjaellands Hospital; Hillerød Denmark
| | - Christian Rothe
- Department of Anaesthesia and Intensive Care Medicine; Copenhagen University Hospital; Nordsjaellands Hospital; Hillerød Denmark
| | - Ulrik Grevstad
- Department of Anaesthesia and Intensive Care Medicine; Copenhagen University Hospital; Gentofte Hospital; Gentofte Denmark
| | - Lars H. Lundstrøm
- Department of Anaesthesia and Intensive Care Medicine; Copenhagen University Hospital; Nordsjaellands Hospital; Hillerød Denmark
| | - Kai H. W. Lange
- Department of Anaesthesia and Intensive Care Medicine; Copenhagen University Hospital; Nordsjaellands Hospital; Hillerød Denmark
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17
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Tran DQ, Salinas FV, Benzon HT, Neal JM. Lower extremity regional anesthesia: essentials of our current understanding. Reg Anesth Pain Med 2019; 44:rapm-2018-000019. [PMID: 30635506 DOI: 10.1136/rapm-2018-000019] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/14/2018] [Accepted: 05/23/2018] [Indexed: 12/16/2022]
Abstract
The advent of ultrasound guidance has led to a renewed interest in regional anesthesia of the lower limb. In keeping with the American Society of Regional Anesthesia and Pain Medicine's ongoing commitment to provide intensive evidence-based education, this article presents a complete update of the 2005 comprehensive review on lower extremity peripheral nerve blocks. The current review article strives to (1) summarize the pertinent anatomy of the lumbar and sacral plexuses, (2) discuss the optimal approaches and techniques for lower limb regional anesthesia, (3) present evidence to guide the selection of pharmacological agents and adjuvants, (4) describe potential complications associated with lower extremity nerve blocks, and (5) identify informational gaps pertaining to outcomes, which warrant further investigation.
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Affiliation(s)
- De Q Tran
- Department of Anesthesiology, McGill University, Montreal, Quebec, Canada
| | - Francis V Salinas
- Department of Anesthesiology, US Anesthesia Partners-Washington, Swedish Medical Center, Seattle, Washington, USA
| | - Honorio T Benzon
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joseph M Neal
- Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington, USA
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Jordahn ZM, Lyngeraa TS, Grevstad U, Rothe C, Lundstrøm LH, Lange KHW. Ultrasound guided repositioning of a new suture-method catheter for adductor canal block - a randomized pilot study in healthy volunteers. BMC Anesthesiol 2018; 18:150. [PMID: 30355334 PMCID: PMC6201513 DOI: 10.1186/s12871-018-0615-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 10/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We performed a randomized, blinded pilot study in 12 volunteers to assess the feasibility to reposition an intentionally displaced suture-method catheter for two different insertion techniques for adductor canal block. METHODS Each volunteer had an ultrasound-guided suture-method catheter placed in the adductor canal (AC) in both legs. The catheters were placed using a perpendicular technique in one leg and a parallel technique in the other leg, according to randomization. 15 mL lidocaine 1% (LA) was injected in each catheter. Successful primary placement was defined as combined LA spread within the AC and loss of cold sensation 15 min after injection. All catheters were intentionally displaced, and subsequently repositioned using ultrasound. Another dose of lidocaine (15 mL 1%) was injected through the catheters and assessed for successful repositioning. RESULTS Successful primary placement was achieved in 83% (95% CI 55-95%) of catheters placed perpendicular to the AC, and in 75% (95% CI 47-91%) of catheters placed parallel to the AC. Of those with successful primary placement, 100% (95% CI 72-100%) of catheters placed perpendicular to the AC, and 67% (95% CI 35-88%)) placed parallel to the AC could be repositioned. CONCLUSIONS Placement and secondary repositioning after displacement of a suture-method catheter within the adductor canal is achievable. A perpendicular technique seems more reliable. TRIAL REGISTRATION NCT03315481 clinicaltrials.gov . The study was submitted on March 1, 2017. Due to clerical error, the study was posted on October 20, 2017.
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Affiliation(s)
- Zarah Maria Jordahn
- Department of Anaesthesia and Intensive Care Medicine, Copenhagen University Hospital, Nordsjællands Hospital, Dyrehavevej 29, 3400, Hillerød, Denmark
| | - Tobias Stenbjerg Lyngeraa
- Department of Anaesthesia and Intensive Care Medicine, Copenhagen University Hospital, Nordsjællands Hospital, Dyrehavevej 29, 3400, Hillerød, Denmark.
| | - Ulrik Grevstad
- Department of Anaesthesia and Intensive Care Medicine, Copenhagen University Hospital, Gentofte Hospital, Kildegårdsvej 28, 2900, Hellerup, Denmark
| | - Christian Rothe
- Department of Anaesthesia and Intensive Care Medicine, Copenhagen University Hospital, Nordsjællands Hospital, Dyrehavevej 29, 3400, Hillerød, Denmark
| | - Lars Hyldborg Lundstrøm
- Department of Anaesthesia and Intensive Care Medicine, Copenhagen University Hospital, Nordsjællands Hospital, Dyrehavevej 29, 3400, Hillerød, Denmark
| | - Kai Henrik Wiborg Lange
- Department of Anaesthesia and Intensive Care Medicine, Copenhagen University Hospital, Nordsjællands Hospital, Dyrehavevej 29, 3400, Hillerød, Denmark
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Büttner B, Dracklé J, Kristof K, Hinz J, Schwarz A, Bauer M, Mansur A, Bergmann I. Paths of femoral nerve catheters placed using ultrasound-guided in plane vs out of plane techniques: A randomized controlled clinical trial. Medicine (Baltimore) 2018; 97:e12958. [PMID: 30412115 PMCID: PMC6221616 DOI: 10.1097/md.0000000000012958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Continuous blockade of the femoral nerve is widely used for postoperative analgesia after hip surgery. It can be achieved by ultrasound-guided placement of a femoral nerve catheter via either the in plane (IP) or out of plane (OOP) technique. On the basis of postoperative radiographs, we evaluated the paths of femoral nerve catheters with respect to both techniques and its effect on postoperative analgesia. METHODS Thirty-four patients were randomized to receive a radiopaque femoral nerve catheter via either the IP or OOP technique. The paths and tip position of the catheters were evaluated in postoperative frontal radiographs of the operated hip joint concerning a predefined target region and four neighboring regions. Pain scores were assessed using a numeric rating scale (0-10). RESULTS Sixteen IP patients and 18 OOP patients were included in the study. The catheter path was radiographically evaluated in 13 IP patients and in 10 OOP patients. The catheter tips were located within the target region in 39% of the IP group and in 50% of the OOP group. The catheter tip was 0.00 cm [-3.80 to 3.84] and -1.19 cm [-12.27 to 0.00] (median [range]) from the target region in the OOP group and IP group, respectively (P = .045). Catheters flipped distally more often in the IP group (IP: 61.5%, OOP: 10.0%; P = .01). There were no marked differences in the pain scores of either group. CONCLUSION Femoral nerve catheters inserted by the ultrasound-guided IP technique flip distally more frequently than catheters inserted by the OOP technique. Moreover, the distance between the catheter tip and the trunk of the femoral nerve is greater for IP catheters than for OOP catheters. Despite these findings, postoperative analgesia did not seem to differ between the 2 techniques.
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Affiliation(s)
- Benedikt Büttner
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center, University of Goettingen, Goettingen
| | - Joschka Dracklé
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center, University of Goettingen, Goettingen
| | - Katalin Kristof
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center, University of Goettingen, Goettingen
| | - José Hinz
- Department of Anesthesiology, Emergency and Intensive Care Medicine, Klinikum Region Hannover, Hannover
| | - Alexander Schwarz
- Department of Neuroradiology, University Medical Center Goettingen, University of Goettingen, Goettingen, Germany
| | - Martin Bauer
- Department of Anesthesiology, Emergency and Intensive Care Medicine, Klinikum Region Hannover, Hannover
| | - Ashham Mansur
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center, University of Goettingen, Goettingen
| | - Ingo Bergmann
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center, University of Goettingen, Goettingen
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Effect of Perineural Dexamethasone on the Duration of Single Injection Saphenous Nerve Block for Analgesia After Major Ankle Surgery: A Randomized, Controlled Study. Reg Anesth Pain Med 2018; 42:210-216. [PMID: 28033159 DOI: 10.1097/aap.0000000000000538] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Patients undergoing major elective ankle surgery often experience pain from the saphenous nerve territory persisting beyond the duration of a single-injection saphenous nerve block. We hypothesized that perineural dexamethasone as an adjuvant for the saphenous nerve block prolongs the duration of analgesia and postpones as well as reduces opioid-requiring pain. METHODS Forty patients were included in this prospective, randomized, controlled study. All patients received a continuous sciatic catheter and were randomized to receive a single-injection saphenous nerve block with 10 mL of 0.5% bupivacaine with 1:200,000 epinephrine with addition of 1 mL of saline or 1 mL of 0.4% (ie, 4 mg) dexamethasone. The primary outcome was duration of saphenous nerve block estimated as the time until the first opioid request. Secondary outcomes were opioid consumption and pain. RESULTS The mean (SD) duration of the saphenous nerve block until first opioid request was 29.4 (8.4) hours in the dexamethasone group and 23.2 (10.3) hours in the control group (P = 0.048). The median opioid consumption [interquartile range] during the first 24 hours was 0 mg [0-0] versus 1.5 mg [0-14.2] in the dexamethasone and control groups, respectively. Nonparametric comparison of opioid consumption from 0 to 24 hours was statistically significant. The opioid consumption was similar in the two groups in the time interval 24 to 48 postoperative hours. CONCLUSION Perineural dexamethasone as an adjuvant for the single-injection subsartorial saphenous nerve block can prolong analgesia and reduce opioid-requiring pain after major ankle surgery.
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21
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In Reply. Anesthesiology 2018; 128:1259-1260. [DOI: 10.1097/aln.0000000000002210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Costoclavicular Approach to the Supraclavicular Fossa: Journey behind the Dark Side of the Moon (Clavicle). Anesthesiology 2018; 128:1259. [DOI: 10.1097/aln.0000000000002209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Hauritz RW, Hannig KE, Henriksen CW, Børglum J, Bjørn S, Bendtsen TF. The effect of perineural dexamethasone on duration of sciatic nerve blockade: a randomized, double-blind study. Acta Anaesthesiol Scand 2018; 62:548-557. [PMID: 29266180 DOI: 10.1111/aas.13054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 11/08/2017] [Accepted: 11/24/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND Major hindfoot and ankle surgery is associated with severe postoperative pain, which is effectively alleviated by combined sciatic and saphenous nerve blockade. Local anaesthetics with added dexamethasone consistently prolongs the duration of pain relief compared to local anaesthetics alone. However, whether the extended duration of pain relief is due to an effect on duration of sensorimotor block per se vs. systemic absorption of the dexamethasone is still not fully elucidated. We aimed to investigate the postoperative duration of sensorimotor blockade with either dexamethasone or saline added to bupivacaine-epinephrine. METHODS Fifty six patients scheduled for surgery were randomly assigned to a popliteal sciatic nerve block of 18 ml 0.5% bupivacaine-epinephrine with either 2 ml of 0.4% dexamethasone or 2 ml 0.9% normal saline added. Sensory and motor functions were tested every 30 min until normalized nerve functions. Primary outcome was time until complete return of sensorimotor functions. RESULTS Mean (SD) time until return of normal sensory and motor functions was 26 (6) vs. 16 (4) hours, P < 0.001, postponing block remission by 10 (95% CI: 8-13) hours. Mean (SD) time until first opioid request was 34 (11) vs. 15 (7) hours, P < 0.001, extending first opioid request by 19 (95% CI: 13-25) hours. Total oral morphine equivalents administered 0-48 h differed significantly between the two groups by 39 (95% CI: 23-55) mg. CONCLUSIONS Addition of 8 mg dexamethasone to 0.5% bupivacaine-epinephrine significantly prolongs the duration of sensorimotor popliteal sciatic nerve blockade, and reduces pain and opioid consumption in patients after major hind foot and ankle surgery.
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Affiliation(s)
- R. W. Hauritz
- Department of Anaesthesiology and Intensive Care Medicine; Kolding Hospital; Kolding Denmark
| | - K. E. Hannig
- Department of Anaesthesiology and Intensive Care Medicine; Kolding Hospital; Kolding Denmark
| | - C. W. Henriksen
- Department of Orthopaedic Surgery; Kolding Hospital; Kolding Denmark
| | - J. Børglum
- Department of Anaesthesiology and Intensive Care Medicine; Zealand University Hospital; University of Copenhagen; Roskilde Denmark
| | - S. Bjørn
- Department of Anaesthesiology and Intensive Care Medicine; Aarhus University Hospital; Aarhus Denmark
| | - T. F. Bendtsen
- Department of Anaesthesiology and Intensive Care Medicine; Aarhus University Hospital; Aarhus Denmark
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Fredrickson M. Promoting the use of peripheral nerve catheters: better catheter accuracy or more user-friendliness? Anaesthesia 2017; 72:939-943. [DOI: 10.1111/anae.13886] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- M. Fredrickson
- Department of Anaesthesiology; University of Auckland; Auckland New Zealand
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Lyngeraa TS, Rothe C, Steen-Hansen C, Madsen MH, Christiansen CB, Andreasen AM, Lundstrøm LH, Lange KHW. Initial placement and secondary displacement of a new suture-method catheter for sciatic nerve block in healthy volunteers: a randomised, double-blind pilot study. Anaesthesia 2017; 72:978-986. [DOI: 10.1111/anae.13933] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2017] [Indexed: 01/07/2023]
Affiliation(s)
- T. S. Lyngeraa
- Department of Anaesthesiology and Intensive Care; Nordsjaellands Hospital and University of Copenhagen; Copenhagen Denmark
| | - C. Rothe
- Department of Anaesthesiology and Intensive Care; Nordsjaellands Hospital and University of Copenhagen; Copenhagen Denmark
| | - C. Steen-Hansen
- Department of Anaesthesiology and Intensive Care; Nordsjaellands Hospital and University of Copenhagen; Copenhagen Denmark
| | - M. H. Madsen
- Department of Anaesthesiology and Intensive Care; Nordsjaellands Hospital and University of Copenhagen; Copenhagen Denmark
| | - C. B. Christiansen
- Department of Anaesthesiology and Intensive Care; Nordsjaellands Hospital and University of Copenhagen; Copenhagen Denmark
| | - A. M. Andreasen
- Department of Anaesthesiology and Intensive Care; Nordsjaellands Hospital and University of Copenhagen; Copenhagen Denmark
| | - L. H. Lundstrøm
- Department of Anaesthesiology and Intensive Care; Nordsjaellands Hospital and University of Copenhagen; Copenhagen Denmark
| | - K. H. W. Lange
- Department of Anaesthesiology and Intensive Care; Nordsjaellands Hospital and University of Copenhagen; Copenhagen Denmark
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Catheter Taping Methods—Single-Layer Versus Reinforced Double-Layer Technique. Reg Anesth Pain Med 2017; 42:128-130. [DOI: 10.1097/aap.0000000000000512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Reply to Drs Johnston and Sondekoppam. Reg Anesth Pain Med 2017. [DOI: 10.1097/aap.0000000000000611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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