Pain
Conditions
Keywords
multiorifice or endhole femoral nerve catheter
Brief summary
Multiorifice catheters have been shown to provide superior analgesia and significantly reduce local anesthetic consumption compared with end-hole catheters in epidural studies. This prospective, blinded, randomized study tested the hypothesis that, in continuous femoral nerve block (CFNB) under ultrasound guidance, multiorifice catheter would reduce local anesthetic consumption at 24h compared with end-hole catheter.
Detailed description
Eighty adult patients (aged ≥18 years) scheduled to undergo primary total knee arthroplasty under a combination of continuous femoral nerve block (CFNB), sciatic nerve block and general anesthesia were randomized to CFNB using either a 3-pair micro-hole (Contiplex, BRAUN®, 20G - 400 mm) or an end-hole (Silverstim VYGON®, 20G - 500 mm) catheter. Once the femoral catheter was sited, a bolus of 20 mL lidocaine 1% was injected. An electronic pump then delivered an automated 5 mL bolus of ropivacaine 0.2% hourly, with 10 mL self-administered patient controlled analgesia boluses.
Interventions
COMBINATION_PRODUCTlidocaine and ropivacaine injection through catheters
injection of local anesthetic through an endhole or a sixhole femoral nerve catheter in the context of total knee replacement. Analgesic properties at 24 and 48h of both groups registered.
Sponsors
University Hospital, Geneva
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Masking description
All investigators, patients, and other clinical staff were blinded to the treatment group. The investigator in charge of the patient was unaware of patient allocation. He did not perform the block or open the sealed and opaque envelope, but followed the patient in the ward. An opaque skin dressing was used in order to blind the type of catheter used. End-hole catheter Vygon is white and stiff whereas six-hole catheter contiplex is yellow and flexible.
Intervention model description
Eighty adult patients (aged ≥18 years) scheduled to undergo primary total knee arthroplasty under a combination of CFNB, sciatic nerve block and general anesthesia were randomized to CFNB using either a 3-pair micro-hole (Contiplex, BRAUN®, 20G - 400 mm) or an end-hole (Silverstim VYGON®, 20G - 500 mm) catheter. Once the femoral catheter was sited, a bolus of 20 mL lidocaine 1% was injected. An electronic pump then delivered an automated 5 mL bolus of ropivacaine 0.2% hourly, with 10 mL self-administered patient controlled analgesia boluses.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* every patient accepting a conitnuous femoral nerve catheter
Exclusion criteria
* pregnancy, * any contraindication to peripheral nerve blockade, * pre-existing peripheral nerve neuropathy, * allergy to LA (study medications), * ASA score ≥4, * neurologic or neuromuscular disease, * psychiatric disease, * renal failure, * hepatic failure, * chronic opioid therapy, * NSAID contraindication, * inability to use a patient controlled analgesia (PCA) device, g * enu valgum, * infection at the injection site or * withdrawal of consent.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| total LA consumption at 24h | 24h after connecting PCA to the femoral nerve catheter | total ropivacaine consumption at 24h in mL |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| morphine requirements at 24h and 48h | morphine consumption at 24h and 48h after completion of surgery | rescue morphine 24h and 48h in mg |
| total LA consumption at 48h | 48h after connecting PCA to the femoral nerve catheter | total ropivacaine consumption at 48h in mL |
| number of boluses of ropivacaine at 24h | 24h after connecting PCA to the femoral nerve catheter | total ropivacaine boluses received at 24h in numbers |
| number of boluses of ropivacaine at 48 h | 48h after connecting PCA to the femoral nerve catheter | total ropivacaine boluses received at 48h in numbers |
| quadriceps strength before surgery and 24h and 48h after surgery | quadriceps strenght before performing femoral nerve block and 24 and 48h after performing the block | quadriceps strength measured with with an electronic dynamometer in N.m and percentage of preblock value of MVIC |
Countries
Switzerland
Outcome results
None listed