Document Detail


Postoperative efficacies of femoral nerve catheters sited using ultrasound combined with neurostimulation compared with neurostimulation alone for total knee arthroplasty.
MedLine Citation:
PMID:  20601891     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND OBJECTIVE: Neurostimulation is commonly used to perform femoral nerve block. Ultrasound can be used to identify nerve structures and guide needle placement. The aim of this study was to compare postoperative analgesic efficiency when femoral nerve catheters were sited using ultrasound (in-plane approach) combined with neurostimulation or neurostimulation alone, for total knee arthroplasty.
METHOD: Ninety-three patients were enrolled in this prospective, randomized, blind study to receive a continuous femoral nerve block performed using conventional neurostimulation or ultrasound guidance combined with neurostimulation. The primary endpoint was the postoperative 48 h total local anaesthetic consumption. Other outcomes included visual analogue scale scores at rest, after 12, 24 and 48 h; total oral opioid dose; onset time of femoral block; procedural time; knee flexion and complications. Results are expressed with medians (25-75th percentiles), mean ± SD and n (%), as appropriate.
RESULTS: The onset time of sensory and motor block was faster in the ultrasound group [11 (6-17) min] than in the conventional group [16 (11-23) min, P = 0.009]. Total local anaesthetic dose was reduced [299 ± 45 vs. 333 ± 48 ml, (difference = 34.0 ml, 95% confidence interval 15.6-52.5 ml), P = 0.0003] and the time to the first analgesic request was lengthened [11 (7-13) vs. 7 (4-12) h, P = 0.034] in the ultrasound group. Visual analogue scale scores at 12, 24 and 48 h were lower in the ultrasound group as well as visual analogue scale scores during knee flexion at 48 h [14.5 (11.0-23.0) vs. 28.5 (21.0-43.5) mm, P < 0.0001]. Total oral morphine doses were 20 (0-40) vs. 40 (20-60) mg (P = 0.0065). Durations of hospital stay were comparable in both groups.
CONCLUSION: Continuous perineural femoral catheter placement using ultrasound combined with neurostimulation and an in-plane approach reduces total doses of local anaesthetic, morphine consumption and improves postoperative pain management by comparison with neurostimulation alone.
Authors:
Christophe Aveline; Alain Le Roux; Hubert Le Hetet; Pierre Vautier; Fabrice Cognet; Francis Bonnet
Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  European journal of anaesthesiology     Volume:  27     ISSN:  1365-2346     ISO Abbreviation:  Eur J Anaesthesiol     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-10-08     Completed Date:  2011-01-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8411711     Medline TA:  Eur J Anaesthesiol     Country:  England    
Other Details:
Languages:  eng     Pagination:  978-84     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology and Surgical Intensive Care, Hôpital Privé Sévigné, Cesson Sévigné, France. caveline@club-internet.fr
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MeSH Terms
Descriptor/Qualifier:
Aged
Arthroplasty, Replacement, Knee / methods*
Catheterization / methods
Combined Modality Therapy
Electric Stimulation Therapy / methods*
Female
Femoral Nerve
Humans
Male
Middle Aged
Nerve Block / methods*
Pain Measurement
Pain, Postoperative / prevention & control*
Prospective Studies
Single-Blind Method
Time Factors
Ultrasonography, Interventional / methods

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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