Continuous Femoral Nerve Blocks

Charous, Matthew T.; Madison, Sarah J.; Suresh, Preetham; Sandhu, NavParkash S.; Loland, Vanessa J.; Mariano, Edward R.; Donohue, Michael C.; Dutton, Pascual H.; Ferguson, Eliza J.; Ilfeld, Brian M.

doi:10.1097/aln.0b013e3182124dc6

Cited by 118 publications

(41 citation statements)

References 34 publications

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“…The HHD is a reliable and valid instrument, and we used standardized, recommended procedures to obtain valid measurements. [14,21] To evaluate the quadriceps muscle strength, we placed the patient in a seated position with the knees flexed 60°. We used a nonelastic strap with Velcro closures to fix the HHD to the leg.…”

Section: Assessmentmentioning

confidence: 99%

“…[3] However, FNB leads to femoral quadriceps muscle weakness. [14,15] Consequently, quadriceps weakness results in functional impairment and it is associated with an increased risk of postoperative falls. [16–18] Thus far, attempts to reduce quadriceps involvement after FNB without compromising analgesia have not been successful.…”

Section: Introductionmentioning

confidence: 99%

“…[16–18] Thus far, attempts to reduce quadriceps involvement after FNB without compromising analgesia have not been successful. [15,19] …”

Section: Introductionmentioning

confidence: 99%

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Adductor canal block versus femoral nerve block combined with sciatic nerve block as an anesthetic technique for hindfoot and ankle surgery

Joe

Choo²,

Yoon³

et al. 2016

Medicine

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Background:A femoral nerve block (FNB) in combination with a sciatic nerve block (SNB) is commonly used for anesthesia and analgesia in patients undergoing hindfoot and ankle surgery. The effects of FNB on motor function, related fall risk, and rehabilitation are controversial. An adductor canal block (ACB) potentially spares motor fibers in the femoral nerve, but the comparative effect on hindfoot and ankle surgeries between the 2 approaches is not yet well defined. We hypothesized that compared to FNB, ACB would cause less weakness in the quadriceps and produce similar pain scores during and after the operation.Methods:Sixty patients scheduled for hindfoot and ankle surgeries (arthroscopy, Achilles tendon surgery, or medial ankle surgery) were stratified randomized for each surgery to receive an FNB (FNB group) or an ACB (ACB group) combined with an SNB. The primary outcome was the visual analog scale (VAS) pain score at each stage. Secondary outcomes included quadriceps strength, time profiles (duration of the block procedure, time to full anesthesia and time to full recovery), patients’ analgesic requirements, satisfaction, and complications related to peripheral nerve blocks such as falls, neurologic symptoms, and local anesthetic systemic toxicity were evaluated. The primary outcome was tested for the noninferiority of ACB to FNB, and the other outcomes were tested for the superiority of each variable between the groups.Results:A total of 31 patients received an ACB and 29 received an FNB. The VAS pain scores of the ACB group were not inferior during and after the operation compared to those of the FNB group. At 30 minutes and 2 hours after anesthesia, patients who received an ACB had significantly higher average dynamometer readings than those who received a FNB (34.2 ± 20.4 and 30.4 ± 23.7 vs 1.7 ± 3.7 and 2.3 ± 7.4, respectively), and the results were similar at 24 and 48 hours after anesthesia. There were no differences between the 2 groups with regard to time profiles and patient satisfaction. No complications were noted.Conclusion:ACB preserved quadriceps muscle strength better than FNB, without a significant difference in postoperative pain. Therefore, ACB may be a good alternative to FNB for reducing the potential fall risk.

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Section: Assessmentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Adductor canal block versus femoral nerve block combined with sciatic nerve block as an anesthetic technique for hindfoot and ankle surgery

Joe

Choo²,

Yoon³

et al. 2016

Medicine

View full text Add to dashboard Cite

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“…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

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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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“…Regional anesthesia in the form of a peripheral nerve block (PNB) can provide substantial pain control after TJR while also limiting the use of opioid medications [9]. However, PNB has the potential to produce muscle weakness, theoretically hindering PT after surgery [10]. These perceived shortcomings of regional anesthesia have led some providers to prefer periarticular infiltration of local anesthetic to improve analgesia while avoiding potential muscle weakness associated with PNB [11].…”

Section: Introductionmentioning

confidence: 99%

Peripheral nerve blocks and postoperative physical therapy: a single-institution survey of physical therapists’ preferences and opinions

McClain

Porter

Arnold

et al. 2017

Rom J Anaesth Intensive Care

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Background and Aims: Our aim was to ascertain the opinions and preferences of physical therapists with regard to use of peripheral nerve blocks and their impact on the recovery of patients undergoing total joint replacement.Methods: We conducted an anonymous 24-question survey of 20 full-time inpatient physical therapists at a single tertiary care medical center.Results: One respondent indicated they never work with patients who have undergone total joint replacement surgery. Nineteen questionnaires were included in the final analysis. Questions omitted by respondents or with write-in answers were not included in the analysis. A majority of respondents (15 [ of respondents would prefer that their patients receive periarticular infiltration or no block at all after total knee arthroplasty or total hip arthroplasty, respectively. All respondents (19 [100%]) answered that they thought lower extremity nerve blocks increased a patient's risk of falling after surgery.Conclusions: According to the physical therapists we surveyed, nerve blocks impede patient recovery and increase the risk of falls, despite their positive impact on pain control. When considering surgery for themselves, therapists indicated they would not want a nerve block.

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Continuous Femoral Nerve Blocks

Cited by 118 publications

References 34 publications

Adductor canal block versus femoral nerve block combined with sciatic nerve block as an anesthetic technique for hindfoot and ankle surgery

Adductor canal block versus femoral nerve block combined with sciatic nerve block as an anesthetic technique for hindfoot and ankle surgery

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

Peripheral nerve blocks and postoperative physical therapy: a single-institution survey of physical therapists’ preferences and opinions

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