Postoperative Analgesia by Femoral Nerve Block With Ropivacaine 0.2% After Major Knee Surgery: Continuous Versus Patient-Controlled Techniques. Issue 6 (1st November 2002)

• Record Type: Journal Article
• Authors: Eledjam, Jean Jacques; Cuvillon, Philippe; Capdevila, Xavier; Macaire, Philippe; Serri, Sylvain; Gaertner, Elisabeth; Jochum, Denis
• Is Part Of: Regional anesthesia and pain medicine. Volume 27:Issue 6(2002)
• Page Start: 604
• Page End: 611
• Publication Date: 2002-11-01
• Subjects: Pain relief -- Local anesthetics -- Peripheral nerve block; Conduction anesthesia -- Periodicals; Pain medicine -- Periodicals; 617.964
• DOI: 10.1053/rapm.2002.36454
• Languages: English
• ISSNs: 1098-7339

Abstract

Abstract : Background and Objectives: This prospective study compared the efficacy and adverse effects after knee surgery of ropivacaine 0.2% administered as patient-controlled femoral analgesia (PCFA), as a continuous femoral infusion (Inf), or as both (PCFA+Inf). Methods: Before general anesthesia, 140 adults scheduled to undergo major knee surgery received a sciatic/fascia iliaca nerve block with 0.75% ropivacaine (40 mL). After surgery, they were randomly assigned to receive, through the femoral catheter, an infusion of 0.2% ropivacaine administered as PCFA (boluses of 10 mL with a lockout time of 60 minutes), Inf (10 mL/h), or PCFA + Inf (5 mL/h plus boluses of 5 mL with a lockout time of 60 minutes). Pain was assessed at rest, on mobilization, and during physiotherapy using a visual analog scale (VAS). Additional use of intravenous (IV) analgesics was noted. Results: Patients in all 3 groups experienced similar pain relief at rest, on mobilization, and after physiotherapy ( P > .05). Additional use of analgesics and overall patient satisfaction (excellent or good in 80% of cases) were also similar in all groups. However, total postoperative ropivacaine consumption was lower in the PCFA group, 150 mL/48 h (90.5 to 210); than in the Inf group, 480 mL/48 h (478 to 480); and the PCFA + Inf group, 310 mL/48 h (280 to 340) ( P < .05). Adverse events were similar in all 3 groups (hypotension, vomiting, insomnia). No paresthesia or motor block were observed. Conclusion: All 3 strategies provided effective pain relief. PCFA resulted in a lower consumption of ropivacaine (toxic and financial impact). PCFA + Inf does not improve postoperative analgesia.