A randomized, triple-masked, active-controlled investigation of the relative effects of dose, concentration, and infusion rate for continuous popliteal-sciatic nerve blocks in volunteers

Madison, Sarah J.; Monahan, Amanda M.; Agarwal, Rishi; Furnish, Timothy; Mascha, Edward J.; Xu, Zhengyu; Donohue, Michael; Morgan, Anya C.

doi:10.1093/bja/aeu333

Cited by 21 publications

(11 citation statements)

References 21 publications

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“…32 This would explain why a previous study reported a larger cephalad-caudad cutaneous effect with the use of a 0.6 mL/kg bolus of levobupivacaine 0.125% compared with a bolus of half this volume—it was not the higher volume but rather the higher dose responsible for the differing results. 16 While the current investigation did compare repeated large (24 mL) bolus volumes with a steady basal infusion of 8 mL/h, the mass of ropivacaine administered was equivalent at Hours 3 and 6.…”

Section: Discussionmentioning

confidence: 98%

Continuous Transversus Abdominis Plane Nerve Blocks: Does Varying Local Anesthetic Delivery Method—Automatic Repeated Bolus Versus Continuous Basal Infusion—Influence the Extent of Sensation to Cold?: A Randomized, Triple-Masked, Crossover Study in Volunteers

Khatibi

Said

Sztain

et al. 2017

Anesthesia &Amp; Analgesia

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Background It remains unknown whether continuous or scheduled intermittent bolus local anesthetic administration is preferable for transversus abdominis plane (TAP) catheters. We therefore tested the hypothesis that when using TAP catheters, providing local anesthetic in repeated bolus doses increases the cephalad-caudad cutaneous effects compared with a basal-only infusion. Methods Bilateral TAP catheters (posterior approach) were inserted in 24 healthy volunteers followed by ropivacaine 2 mg/mL administration for a total of 6 hours. The right side was randomly assigned to either a basal infusion (8 mL/h) or bolus doses (24 mL administered every 3 hours for a total of 2 bolus doses) in a double-masked manner. The left side received the alternate treatment. The primary endpoint was the extent of sensory deficit as measured by cool roller along the axillary line at Hour 6 (6 hours after the local anesthetic administration was initiated). Secondary endpoints included the extent of sensory deficit as measured by cool roller and Von Frey filaments along the axillary line and along a transverse line at the level of the anterior superior iliac spine at Hours 0–6. Results While there were statistically significant differences between treatments within the earlier part of the administration period, by Hour 6 the difference in extent of sensory deficit to cold failed to reach statistical significance along the axillary line (mean=0.9 cm; SD=6.8; 95% CI −2.0, 3.8; p=0.515) and transverse line (mean=2.5 cm; SD=10.1; 95% CI −1.8, 6.8; p=0.244). While the difference between treatments was statistically significant at various early time points for the horizontal, vertical and estimated area measurements of both cold and mechanical pressure sensory deficits, no comparison remained statistically significant by Hour 6. Conclusion No evidence was found in this study involving healthy volunteers to support the hypothesis that changing the local anesthetic administration technique (continuous basal versus hourly bolus) when using ropivacaine 0.2% and TAP catheter at 8 mL/h and 24 mL every 3 hours significantly influences the cutaneous effects after 6 hours of administration. Additional research is required to determine whether changing variables (e.g., local anesthetic concentration, basal infusion rate, bolus dose volume and/or interval) would provide different results.

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Section: Discussionmentioning

confidence: 98%

Continuous Transversus Abdominis Plane Nerve Blocks: Does Varying Local Anesthetic Delivery Method—Automatic Repeated Bolus Versus Continuous Basal Infusion—Influence the Extent of Sensation to Cold?: A Randomized, Triple-Masked, Crossover Study in Volunteers

Khatibi

Said

Sztain

et al. 2017

Anesthesia &Amp; Analgesia

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“…19 In our institutional pilot data, administration of 15-ml boluses of 0.5% ropivacaine in the adductor canal at 6-h intervals (total dose 300 mg in 24 h) resulted in satisfactory pain relief after arthroscopic ACL surgery. 20 Given that the block effect depended on the local anaesthetic dose, 21 we selected an identical total dose of 300 mg of ropivacaine to be delivered in 24 h in each group. A higher concentration of local anaesthetic at a lower infusion rate was demonstrated to be as effective as a lower concentration of local anaesthetic administered at higher infusion rates.…”

Section: Discussionmentioning

confidence: 99%

“…A higher concentration of local anaesthetic at a lower infusion rate was demonstrated to be as effective as a lower concentration of local anaesthetic administered at higher infusion rates. 20 Given that the block effect depended on the local anaesthetic dose, 21 we selected an identical total dose of 300 mg of ropivacaine to be delivered in 24 h in each group. Accordingly, an infusion of 12.5 mg/h or 2.5 ml/h of 0.5% ropivacaine was calculated for administration in the continuous group.…”

Section: Discussionmentioning

confidence: 99%

Post‐operative analgesia using intermittent vs. continuous adductor canal block technique: a randomized controlled trial

Thapa

Ahuja

Verma

et al. 2016

Acta Anaesthesiol Scand

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“…163,164 Relatedly, providing local anesthetic as automatic, repeated bolus doses does not change block effects compared with a continuous basal infusion, as long as the total dose remains constant. 156,165,166 Similarly, no additive has demonstrated improved analgesia and/or decreased motor block, including epinephrine [167][168][169] and clonidine. [170][171][172] One of the most promising fall-reduction interventions is converting continuous femoral to adductor canal nerve blocks, owing to the demonstrated reduction of induced quadriceps weakness.…”

Section: Ketaminementioning

confidence: 99%

Anesthesia and Analgesia Practice Pathway Options for Total Knee Arthroplasty

Kopp

Børglum

Buvanendran

et al. 2017

Regional Anesthesia and Pain Medicine

163

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In 2014, the American Society of Regional Anesthesia and Pain Medicine in collaboration with the European Society of Regional Anaesthesia and Pain Therapy convened a group of experts to compare pathways for anesthetic and analgesic management for patients undergoing total knee arthroplasty in North America and Europe and to develop a practice pathway. This review is intended to be an analysis of the current literature to assist individuals and institutions in designing a pathway for total knee arthroplasty that is based on existing evidence and expert recommendation and may be customized according to individual settings.

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A randomized, triple-masked, active-controlled investigation of the relative effects of dose, concentration, and infusion rate for continuous popliteal-sciatic nerve blocks in volunteers

Abstract: NCT01898689.

Cited by 21 publications

References 21 publications

Continuous Transversus Abdominis Plane Nerve Blocks: Does Varying Local Anesthetic Delivery Method—Automatic Repeated Bolus Versus Continuous Basal Infusion—Influence the Extent of Sensation to Cold?: A Randomized, Triple-Masked, Crossover Study in Volunteers

Continuous Transversus Abdominis Plane Nerve Blocks: Does Varying Local Anesthetic Delivery Method—Automatic Repeated Bolus Versus Continuous Basal Infusion—Influence the Extent of Sensation to Cold?: A Randomized, Triple-Masked, Crossover Study in Volunteers

Post‐operative analgesia using intermittent vs. continuous adductor canal block technique: a randomized controlled trial

Anesthesia and Analgesia Practice Pathway Options for Total Knee Arthroplasty

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