<p>Comparison of Effectiveness of Ropivacaine Infusion Regimens for Continuous Femoral Nerve Block for Recovery After Total Knee Arthroplasty: A Randomized Double-Blind Trial</p>

Abstract

Continuous femoral nerve block (cFNB) is effective for analgesia after total knee arthroplasty (TKA). However, it is not clear which low-dose regimen of ropivacaine infusion for cFNB provides adequate analgesia and enables rapid recovery. The aim of this study was to compare the effects of different cFNB regimens on rehabilitation of patients after TKA. Patients and Methods: Sixty patients scheduled for TKA were enrolled in this trial. After surgery, patients in the 0.1%, 0.15%, and 0.2% groups received infusion of 10 mL of 0.1%, 6.7 mL of 0.15%, and 5 mL of 0.2% ropivacaine per hour, respectively (n=20), at the dose of 10 mg/h for 48 h. The primary endpoint was time to readiness for discharge. The secondary endpoints were time to first walk, manual muscle testing (MMT) scores, numerical rating scale (NRS) scores at rest and movement, morphine consumption, rescue analgesia, and the incidence of adverse events. Results: The time to readiness for discharge and the time to first walk of the 0.1% group were significantly longer than that of the 0.15% and 0.2% groups. MMT scores of the 0.2% group at 18 h after surgery were significantly lower than those of the 0.1% group. MMT scores of the 0.2% group at 24 and 48 h after surgery were also significantly lower than those of the 0.1% and 0.15% groups. NRS scores at rest and at movement in the 0.1% group were significantly higher than those in the 0.15% and 0.2% groups. Conclusion: Patients administered the regimens of 0.15% and 0.2% ropivacaine infusion for cFNB were ready for discharge earlier than the 0.1% group after TKA, at the dose of 10 mg/h for 48 h. The regimen of 0.15% ropivacaine, which is associated with less quadriceps muscle strength weakness than 0.2%, is recommended for postoperative analgesia after TKA.

Outpatient Surgery in Total Hip and Knee Athroplasty - A Review Article

“…Multimodal, opiate-sparing analgesic regimens should be initiated the morning of surgery, and intraoperative anesthetic care should be tailored to facilitate nausea control and early ambulation with a goal of meeting dismissal criteria later that day. [21] Most studies used Paracetamol 1G orally the morning of surgery [9,10,12,18,22] in addition to Celecoxib 400mg orally [9,10,22]. Additional medications added include Pregabalin 75mg orally [10,22] and Temazapam [12].…”

“…Patients receiving NA had a significantly shorter LOS (total hip arthroplasty [THA]: GA 1.74 vs NA 1.36 days, P < .001; Total Knee Arthroplasty [TKA]: GA 1.77 vs NA 1.64 days, P < .001) Patients receiving NA were more likely to be discharged home (THA: GA 83.4% vs NA 92.3%, P < .001; TKA: GA 83.3% vs NA 86.3%, P = .010). Some smaller studies also have advocated for the use of ropivacaine for total knee surgery and mepivacaine for total hip surgery as agents for neuraxial anesthesia in the rapid recovery context [21,24] Currently there is no consensus if NA or GA should be used for rapid discharge. Both techniques have been used successfully in rapid discharge and outpatient surgery protocols [9][10][11][12][13]18,22,24,27].…”

“…Satisfaction was rated as 80% very satisfied and 20% satisfied in the outpatient surgery group [14,39]. When comparing satisfaction between the inpatient and outpatient surgery group, there was no clinically significant difference [40,[42][43][44][45][46][47][48][49][50][51][52][53].…”

Comparison of ropivacaine plus sufentanil and ropivacaine plus dexmedetomidine for labor epidural analgesia

“…[ 9 , 10 ] Ropivacaine is local anesthetic agent which is widely used in the surgical procedure for pain control, including general surgery, joint arthroplasties, and cardiac surgery. [ 11 ] The combined use of ropivacaine with opioid, such as sufentanil, in epidural anesthesia has a significant effect on postoperative pain management, but opioid have adverse reactions such as vomiting, headache, urinary retention, and respiratory depression. [ 12 , 13 ] Dexmedetomidine is an a2-adrenoceptor agonist with high selectivity.…”

Simultaneous Determination of Ropivacaine and 3-Hydroxy Ropivacaine in Cerebrospinal Fluid by UPLC-MS/MS

“…Ropivacaine is mainly metabolized in the liver, and its metabolites have a weak local anesthetic effect [ 6 ]. Clinically, it is mainly used for regional block anesthesia and epidural anesthesia [ 7 , 8 ]. It is also used for regional block analgesia, such as analgesia after epidural surgery or labor [ 9 ].…”