Margaretha B Breebaart, Jordi Branders, Luc Sermeus, Sultan Termurziev, Helene Camerlynck, Lennert Van Putte, Marnik Van Putte Minelli, Stefan De Hert
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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.</p><p><strong>Patients and methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":null,"pages":null},"PeriodicalIF":1.5000,"publicationDate":"2021-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0a/93/lra-14-43.PMC8007557.pdf","citationCount":"2","resultStr":"{\"title\":\"Levobupivacaine Consumption in Automated Intermittent Bolus in Ultrasound Guided Subparaneural Sciatic Nerve Catheters: A Prospective Double-Blind Randomized Trial.\",\"authors\":\"Margaretha B Breebaart, Jordi Branders, Luc Sermeus, Sultan Termurziev, Helene Camerlynck, Lennert Van Putte, Marnik Van Putte Minelli, Stefan De Hert\",\"doi\":\"10.2147/LRA.S299870\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>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.</p><p><strong>Patients and methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>Programmed bolus administration in subparaneural sciatic nerve catheters reduces LA consumption 48 hours after surgery with equal analgesia and patient satisfaction. 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引用次数: 2
摘要
目的:连续的坐骨神经阻滞已被证实对足部手术后的术后镇痛有好处。然而,最佳的管理模式仍然是争论的焦点。超声引导下神经旁下注射加速了单次坐骨神经阻滞后的起效时间和持续时间。这项双盲前瞻性随机试验比较了拇外翻手术后48小时局部麻醉(LA)剂量消耗的自动间歇丸技术和连续输注方案的坐骨神经下导管。患者和方法:安排拇外翻手术的患者随机接受以5mL/h持续输注0.125%左旋布比卡因(a组)或以0.1 mL/h的背景剂量每2小时间歇自动输注9.8 mL (B组),均为6 mL PCA输注,闭锁30分钟。记录48小时LA消耗、PCA剂量、数值评定量表(NRS)、满意度和正常感觉恢复情况。结果:16例患者因违反方案或技术问题被排除,42例患者留待分析。48 h罗哌卡因用量A组(293±60 mL)高于B组(257±33 mL)。两组间NRS评分中位、最高及患者满意度无统计学差异。术后75±22小时(A组)和70±17小时(B组)感觉恢复正常。结论:术后48小时,经神经旁下坐骨神经导管的程序性大剂量给药可减少LA消耗,镇痛效果和患者满意度相同。感觉的恢复是可变的,可以持续75小时以上。
Levobupivacaine Consumption in Automated Intermittent Bolus in Ultrasound Guided Subparaneural Sciatic Nerve Catheters: A Prospective Double-Blind Randomized Trial.
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.