Continuous Adductor Canal Blocks: Does Varying Local Anesthetic Delivery Method (Automatic Repeated Bolus Doses Versus Continuous Basal Infusion) Influence Cutaneous Analgesia and Quadriceps Femoris Strength? A Randomized, Double-Masked, Controlled, Split-Body Volunteer Study

Monahan, Amanda M.; Sztain, Jacklynn F.; Khatibi, Bahareh; Furnish, Timothy; Jæger, Pia; Sessler, Daniel I.; Mascha, Edward J.; You, Jing; Wen, Cindy; Nakanote, Ken A.

doi:10.1213/ane.0000000000001182

Cited by 21 publications

(7 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Firstly, our blocks were performed at mid-thigh. There exists some controversy as to the optimal location on the thigh for adductor canal block (as well as the nomenclature) [ 9 , 14 ], but since this is the approach that most investigators report [ 10 , 32 – 34 ], we determined it was a valid model. Notwithstanding, our results should be interpreted with this specific anatomic location in mind, and we cannot be certain that femoral nerve block would be superior to an adductor canal block performed at a substantially more proximal location.…”

Section: Discussionmentioning

confidence: 99%

The relative analgesic value of a femoral nerve block versus adductor canal block following total knee arthroplasty: a randomized, controlled, double-blinded study

Gadsden

Sata

Bullock

et al. 2020

Korean J Anesthesiol

View full text Add to dashboard Cite

Background: Multiple comparative studies report that adductor canal blocks provide similar pain relief to femoral nerve blocks following total knee arthroplasty. However, adductor canal blockade fails to anesthetize several important femoral nerve branches that contribute to knee innervation. We sought to clarify this anatomic discrepancy by performing both blocks in sequence, using patients as their own controls. We hypothesized that patients would experience additional pain relief following a superimposed femoral nerve block, demonstrating that these techniques are not equivalent.Methods: Sixteen patients received continuous adductor canal block before undergoing knee arthroplasty under general anesthesia. In the recovery room, patients reported their pain score on a numeric scale of 0–10. Once a patient reached a score of five or greater, he/she was randomized to receive an additional femoral nerve block using 2% chloroprocaine or saline sham, and pain scores recorded every 5 min for 30 min. Patients received opioid rescue as needed. Anesthesiologists performing and assessing block efficacy were blinded to group allocation.Results: Patients randomized to chloroprocaine versus saline reported significantly improved median pain scores 30 min after the femoral block (2.0 vs. 5.5, P = 0.0001). Patients receiving chloroprocaine also required significantly fewer morphine equivalents during the 30 min post-femoral block (1.0 vs. 4.5 mg, P = 0.03).Conclusions: Adductor canal block is a useful technique for postoperative pain following total knee arthroplasty, but it does not provide equivalent analgesic efficacy to femoral nerve block. Future studies comparing efficacy between various block sites along the thigh are warranted.

show abstract

Section: Discussionmentioning

confidence: 99%

The relative analgesic value of a femoral nerve block versus adductor canal block following total knee arthroplasty: a randomized, controlled, double-blinded study

Gadsden

Sata

Bullock

et al. 2020

Korean J Anesthesiol

View full text Add to dashboard Cite

show abstract

“…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. Supporting this theory are three negative studies comparing a basal infusion and repeated bolus doses of equivalent local anesthetic mass for interscalene, 22 femoral, 21 and adductor canal 23 catheters.…”

Section: Discussionmentioning

confidence: 95%

“…21–23 As with other aspects of continuous peripheral nerve blocks, effects often vary depending upon the anatomy of the catheter location. 24 The relationship between administration strategy and ensuing effects remains unexamined for TAP catheters.…”

Section: Introductionmentioning

confidence: 99%

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

Self Cite

View full text Add to dashboard Cite

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.

show abstract

“…Our study is unique relative to nearly all previous investigations comparing automated boluses to a basal infusion in that (1) we included an integrated start-delay timer; (2) we did not define a maximum treatment period but rather removed catheters only after reservoir exhaustion; (3) we collected data 6 days after surgery, which is two to three times longer than previous investigations; and (4) we decreased mandatory average hourly local anesthetic delivery, while most others compared equivalent volumes/doses. 6–20,30–32…”

Section: Discussionmentioning

confidence: 99%

“…6 To date, nearly all trials involving ultrasound-guided catheter insertion adjacent to various peripheral nerves have failed to detect analgesic superiority of one administration modality over the other with equivalent hourly local anesthetic volume and dose, especially with the addition of patient-controlled boluses. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] While this suggests that switching from basal to automated boluses is unwarranted, 21 if the latter allows for a decrease in hourly anesthetic consumption while providing noninferior analgesia, it could prolong anesthetic administration and therefore analgesia. For outpatients with a fixed-volume reservoir, automated intermittent boluses offer two different opportunities to improve postoperative analgesia: (1) in the few initial postoperative days and (2) after the time when a basal infusion would have exhausted the anesthetic reservoir.…”

mentioning

confidence: 99%

Basal InfusionversusAutomated Boluses and a Delayed Start Timer for “Continuous” Sciatic Nerve Blocks after Ambulatory Foot and Ankle Surgery: A Randomized Clinical Trial

et al. 2022

Self Cite

View full text Add to dashboard Cite

Background. The common technique using a basal infusion for an ambulatory continuous peripheral nerve blocks frequently results in exhaustion of the local anesthetic reservoir prior to resolution of surgical pain. We sought to improve and prolong analgesia by delaying initiation using an integrated timer and delivering a lower hourly volume of local anesthetic as automated boluses. We hypothesized that, compared with a traditional continuous infusion, ropivacaine administered with automated boluses at a lower dose and 5-hour delay would (1) provide at least noninferior analgesia [difference in average pain no greater than 1.7 points] while both techniques were functioning [average pain score day after surgery]; and, (2) result in a longer duration [dual primary outcomes]. Methods. Participants (n = 70) undergoing foot or ankle surgery with a popliteal-sciatic catheter received an injection of ropivacaine 0.5% with epinephrine (20 mL) then were randomized to receive ropivacaine (0.2%) as either continuous infusion (6 mL/h) initiated prior to discharge, or automated boluses (8 mL every 2 h) initiated 5 hours following discharge using a timer. Both groups could self-deliver supplemental boluses (4 mL, lockout 30 min); participants and outcomes assessors were blinded to randomization. All randomized participants were included in data analysis. Results. The day following surgery, participants with automated boluses had a median [IQR] pain score of 0.0 [0.0 to 3.0] vs. 3.0 [1.8 to 4.8] for the continuous infusion group: odds ratio 3.1 (95% CI 1.23 to 7.84, p=0.033) adjusting for BMI. Reservoir exhaustion in automated boluses group occurred after a median [IQR] of 119 h [109,125] vs. 74 h [57,80] for continuous infusion group: difference 47h (95% CI: 38 to 55), P<0.001 adjusting for BMI. Conclusions For popliteal-sciatic catheters, replacing a continuous infusion initiated before discharge with automated boluses and a start-delay timer resulted in better analgesia and longer infusion duration.

show abstract

Continuous Adductor Canal Blocks: Does Varying Local Anesthetic Delivery Method (Automatic Repeated Bolus Doses Versus Continuous Basal Infusion) Influence Cutaneous Analgesia and Quadriceps Femoris Strength? A Randomized, Double-Masked, Controlled, Split-Body Volunteer Study

Cited by 21 publications

References 28 publications

The relative analgesic value of a femoral nerve block versus adductor canal block following total knee arthroplasty: a randomized, controlled, double-blinded study

The relative analgesic value of a femoral nerve block versus adductor canal block following total knee arthroplasty: a randomized, controlled, double-blinded study

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

Basal InfusionversusAutomated Boluses and a Delayed Start Timer for “Continuous” Sciatic Nerve Blocks after Ambulatory Foot and Ankle Surgery: A Randomized Clinical Trial

Contact Info

Product

Resources

About