Low Volume and High Concentration of Local Anesthetic Is More Efficacious than High Volume and Low Concentration in Labat's Sciatic Nerve Block: A Prospective, Randomized Comparison

Muñiz, Manuel Taboada; Rodríguez, Jaime; Bermúdez, Martha; Valiño, Cristina; Blanco, Noemi; Amor, Marcos; Aguirre, Pilar; Masid, Ana; Cortés, J; Álvarez, J.; Atanassoff, Peter G.

doi:10.1213/ane.0b013e318186641d

Cited by 45 publications

(30 citation statements)

References 23 publications

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“…8 For transgluteal sciatic nerve blocks, Taboada Muñiz et al 8 observed that, compared with mepivacaine 1% (30 mL), mepivacaine 1.5% (20 mL) resulted in a higher success rate as well as a shorter onset time for sensory and motor block. Similarly, Smith and Siggins 7 found that, compared with prilocaine 1% (0.25 mL/kg), prilocaine 3% (0.08 mg/kg) provided a quicker sensory and motor block.…”

Section: Discussionmentioning

confidence: 99%

A Randomized Comparison Between 3 Combinations of Volume and Concentration of Lidocaine for Ultrasound-Guided Infraclavicular Block

González

Bernucci

Techasuk

et al. 2013

Regional Anesthesia and Pain Medicine

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Section: Discussionmentioning

confidence: 99%

A Randomized Comparison Between 3 Combinations of Volume and Concentration of Lidocaine for Ultrasound-Guided Infraclavicular Block

González

Bernucci

Techasuk

et al. 2013

Regional Anesthesia and Pain Medicine

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“…In a separate study, PNB with a higher concentration of local anesthetic was associated with increased success rate, decreased postoperative pain scores, and prolonged duration of analgesia, compared to lower anesthetic concentration of the same volume 11. In addition, PNB with lower volume and higher concentration of local anesthetic was more efficacious than higher volumes and lower concentrations of local anesthetic of equivalent dose 12,13…”

Section: Introductionmentioning

confidence: 90%

Femoral nerve blockade using various concentrations of local anesthetic for knee arthroscopy in the pediatric population

Veneziano¹,

Tripi²,

Tumin³

et al. 2016

JPR

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BackgroundFemoral nerve blockade (FNB) provides effective postoperative analgesia in children undergoing arthroscopic knee surgery as evidenced by their opioid-sparing effects and decreased postoperative pain scores. Increasing the local anesthetic concentration in peripheral nerve blockade for adults undergoing orthopedic surgery has been shown to be beneficial, increasing block success rate, and providing a longer duration of analgesia. The effect of increasing the concentration of local anesthetic in extremity blocks in children remains largely unexplored.MethodsWe retrospectively evaluated the effectiveness of FNB using three concentrations of local anesthetic (ropivacaine 0.2%, bupivacaine 0.25%, and ropivacaine 0.5%) in children and adolescents undergoing arthroscopic knee surgery. The primary outcome evaluated was postoperative opioid consumption before discharge. Secondary outcomes included post-anesthesia care unit (PACU) and hospital discharge times, first pain score in PACU, and the incidence of adverse events.ResultsTwo hundred and sixty-nine children and adolescents who received a FNB for arthroscopic knee surgery from January 2010 to December 2013 were included for analysis. Local anesthetic used in FNB was ropivacaine 0.2% in 116 (43%) cases, ropivacaine 0.5% in 75 (28%) cases, and bupivacaine 0.25% in 78 (29%) cases. Median postoperative opioid consumption (mg/kg intravenous morphine equivalents) in the ropivacaine 0.5% group was 0 mg/kg (interquartile ranges [IQR]: 0 mg, 0.03 mg/kg) compared to 0.02 mg/kg (IQR: 0, 0.08 mg/kg) in the ropivacaine 0.2% group and 0.01 mg/kg (IQR: 0, 0.08 mg/kg) in the bupivacaine 0.25% group (p=0.009). Median PACU time was shortest in the ropivacaine 0.5% group (47 min; IQR: 36, 68 min) compared to the ropivacaine 0.2% (58 min; IQR: 41, 77) and bupivacaine 0.25% (54 min; IQR: 35, 75 min) groups (p=0.040). Among groups, there were no significant differences in first postoperative pain scores or incidence of nausea and vomiting. No patient in any group experienced a serious adverse event.ConclusionThe results suggest that ropivacaine 0.5% for FNB offers superior postoperative analgesia in the form of decreased postoperative opioid consumption and earlier PACU/hospital discharge, when compared to ropivacaine 0.2% and bupivacaine 0.25% in the pediatric population.Level of evidenceIII, Retrospective Comparative Study.

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“…24Y26,29,30,34,36Y38,41,42 Partial or complete sensory and motor block comprised a component of block success in 5 trials. 32,33,39,40,43 Five trials either wholly or partially defined block success as no conversion to GA. 28,32,35,43,44 Table 2 presents the various definitions of block success used by the source trials reviewed.…”

Section: Definition Of Block Successmentioning

confidence: 99%

The Definition of Block “Success” in the Contemporary Literature

Abdallah

Brull

2012

Regional Anesthesia and Pain Medicine

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A successful nerve block is the common goal that shapes modern regional anesthesia practice and research, yet the meaning of block "success" can be open to interpretation. For this Special Article, we reviewed all applicable randomized controlled trials published over the last decade to determine the most commonly used definitions of block success. We also sought to uncover which relevant indicators of block success are routinely reported in the contemporary literature. Twenty-two trials that explicitly designated the term block "success" as their primary outcome measure were identified. The most common definition of block success was the achievement of a surgical block within a designated period, used in half of the trials. Block success was inconsistently defined in the remaining 11 trials. Patient-related indicators of block success including postoperative pain and patient satisfaction were measured in only 4 trials, whereas anesthesiologist-related indicators such as block onset time and complications were reported most frequently. Surgeon- and hospital administrator-related indicators were not collected in any trial. We found that the definition of block success is highly variable in the contemporary regional anesthesia literature. Our findings underscore the clear and present need for a comprehensive definition of block success, whereas future research should endeavor to capture the indicators of block success that are important to all key perioperative stakeholders.

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Low Volume and High Concentration of Local Anesthetic Is More Efficacious than High Volume and Low Concentration in Labat's Sciatic Nerve Block: A Prospective, Randomized Comparison

Abstract: In Labat's sciatic nerve blockade, administering a low volume and a high concentration of local anesthetic (1.5% mepivacaine) is associated with a higher success rate and a shorter onset time than a high volume and a low concentration of solution (1% mepivacaine).

Cited by 45 publications

References 23 publications

A Randomized Comparison Between 3 Combinations of Volume and Concentration of Lidocaine for Ultrasound-Guided Infraclavicular Block

A Randomized Comparison Between 3 Combinations of Volume and Concentration of Lidocaine for Ultrasound-Guided Infraclavicular Block

Femoral nerve blockade using various concentrations of local anesthetic for knee arthroscopy in the pediatric population

The Definition of Block “Success” in the Contemporary Literature

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