Ropivacaine versus Bupivacaine for 3-in-l Block during Total Knee Arthroplasty

Theodosiadis, Panagiotis; Sachinis, Nikolaos Platon; Goroszeniuk, T; Grosomanidis, Vasilios; Chalidis, Byron

doi:10.1177/230949901302100307

Cited by 16 publications

(7 citation statements)

References 25 publications

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“…Meftah M et al 27 combined a femoral nerve block and patient-controlled epidural analgesia; they used bupivacaine for the block and infiltration, while others 5 , 25 , 26 , 28 , 29 used ropivacaine. Theodosiadis P et al compared the efficacy and safety of ropivacaine and bupivacaine for a 3-in-1 block during total knee arthroplasty and found that ropivacaine and bupivacaine had similar analgesic effects 31 . Muldoon T et al determined that ropivacaine was associated with slightly higher pain scores than bupivacaine was, but the mean value of the difference might not reflect a significant clinical difference 32 .…”

Section: Discussionmentioning

confidence: 99%

Analgesia for total knee arthroplasty: a meta-analysis comparing local infiltration and femoral nerve block

Mei¹,

Jin²,

Chen³

et al. 2015

Clinics

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Patients frequently experience postoperative pain after a total knee arthroplasty; such pain is always challenging to treat and may delay the patient's recovery. It is unclear whether local infiltration or a femoral nerve block offers a better analgesic effect after total knee arthroplasty.We performed a systematic review and meta-analysis of randomized controlled trials to compare local infiltration with a femoral nerve block in patients who underwent a primary unilateral total knee arthroplasty. We searched Pubmed, EMBASE, and the Cochrane Library through December 2014. Two reviewers scanned abstracts and extracted data. The data collected included numeric rating scale values for pain at rest and pain upon movement and opioid consumption in the first 24 hours. Mean differences with 95% confidence intervals were calculated for each end point. A sensitivity analysis was conducted to evaluate potential sources of heterogeneity.While the numeric rating scale values for pain upon movement (MD-0.62; 95%CI: -1.13 to -0.12; p=0.02) in the first 24 hours differed significantly between the patients who received local infiltration and those who received a femoral nerve block, there were no differences in the numeric rating scale results for pain at rest (MD-0.42; 95%CI:-1.32 to 0.47; p=0.35) or opioid consumption (MD 2.92; 95%CI:-1.32 to 7.16; p=0.18) in the first 24 hours.Local infiltration and femoral nerve block showed no significant differences in pain intensity at rest or opioid consumption after total knee arthroplasty, but the femoral nerve block was associated with reduced pain upon movement.

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Section: Discussionmentioning

confidence: 99%

Analgesia for total knee arthroplasty: a meta-analysis comparing local infiltration and femoral nerve block

Mei¹,

Jin²,

Chen³

et al. 2015

Clinics

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“…The local anesthetic used was ropivacaine, which has low toxicity, a rapid onset, and a prolonged anesthetic effect. 16,17 ISB was performed before general anesthesia induction using the ultrasound-guided "in-plane" technique with the patient in the supine position by an experienced anesthesiologist. A 21-gauge SonoPlex Stim needle (Pajunk Medical Systems, Tucker, GA) was inserted into the interscalene groove.…”

Section: Nerve Block and Surgical Techniques And Postoperative Carementioning

confidence: 99%

Multimodal nerve injection provides noninferior analgesic efficacy compared with interscalene nerve block after arthroscopic rotator cuff repair

Park

Jang

et al. 2021

J Orthop Surg (Hong Kong)

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Purpose: This randomized noninferiority trial aimed to evaluate whether combined suprascapular, axillary nerve, and the articular branch of lateral pectoral nerve block (3NB) is noninferior to interscalene nerve block (ISB) for pain control after arthroscopic rotator cuff repair (ASRCR). Materials and Methods: Eighty-five patients undergoing ASRCR were randomized to either 3NB (n = 43) or ISB (n = 42) group. We used 5 and 15 ml of 0.2% ropivacaine for each nerve in the 3NB and ISB groups, respectively. The primary outcome was the visual analog scale (VAS) pain score at 4 h postoperatively measured assessed on an 11-point scale (ranging from 0 = no pain to 10 = worst pain) that was analyzed using noninferiority testing. The secondary outcome was VAS pain scores in the recovery room and at 8, 12, 24, 36, 48, and 72 h postoperatively. Rebound pain, IV-PCA usage during 48 h, dyspnea, muscle weakness, and satisfaction were evaluated. Results: Regarding the primary outcome, the mean difference in VAS pain scores between the 3NB (2.5 ± 1.6) and ISB (2.2 ± 2.3) groups at 4 h postoperatively was 0.3, with a 95% confidence interval (CI) of −0.56 to 1.11. The upper limit of 95% CI is lower than the noninferiority margin of 1.3 ( p < 0.001). At all other time points, except in the recovery room, 3NB showed noninferior to ISB. Rebound pain, IV-PCA usage during the second 24 h, and muscle weakness were lower in the 3NB group (all p < 0.005). The satisfaction was similar in both groups ( p = 0.815). Conclusion: Combined 3NB is noninferior to ISB in terms of pain control after ASRCR; and is associated with low levels of rebound pain, IV-PCA usage, and muscle weakness. Level of evidence: Randomized controlled trial, Level I.

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“…who performed 3-in-1 block following TKA and compared ropivacaine (398 min) with bupivacaine (367 min) ( P = 0.62). [ 6 ] This difference from our study could be due to the blind technique of block administration (3-in-1 block) versus ultrasound-guided FNB and the use of dexmedetomidine with ropivacaine to prolong the analgesia.…”

Section: Discussionmentioning

confidence: 64%

Comparison of intra-articular analgesia and femoral nerve block for postoperative pain relief in unilateral total knee arthroplasty: A randomized clinical study

et al. 2020

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Background and Aims: Femoral nerve block (FNB) and intra-articular analgesia (IAA) are used for postoperative analgesia after total knee arthroplasty (TKA). Aims and Objectives: We aimed to determine the better technique among the two, with regard to duration and quality of postoperative analgesia along with 24-h rescue analgesic consumption. The functional recovery in the early postoperative period was also assessed. Settings and Design: This was a prospective double-blind study comprising 40 American Society of Anesthesiologists I–III patients undergoing elective TKA who were randomly assigned to two groups ( n = 20). Methodology: In Group A, 20 mL ropivacaine 0.5%, containing dexmedetomidine (1 μg.kg − 1 ), was given by FNB, and in Group B, intra-articular administration of the same drug was done. Analgesic effect was evaluated by measuring the Visual Analog Scale (VAS) and duration of analgesia. Quadriceps muscle strength was noted. Statistical Analysis: Observation data obtained were reported as mean value and analyzed using Student's t -test or Wilcoxon/Mann–Whitney rank test. Results: The mean VAS on passive movement at the 2 nd , 6 th , and 16 th h postoperatively was 1.75 ± 0.44, 2.90 ± 0.72, and 2.75 ± 0.44 in Group A as compared to 2.25 ± 0.72, 4.30 ± 2.05, and 2.20 ± 0.77 in Group B ( P = 0.026, 0.043, and 0.014, respectively). In Group A, the first request for analgesic (rescue analgesic) was at 637 ± 119 min and the total consumption of tramadol was 50.00 mg. In Group B, the first request for analgesic was at 404.44 ± 136 min, with a total dose of 63.89 mg. The Pvalue for the time of rescue analgesic was <0.001, while for total drug consumption, it was 0.018. Conclusion: We concluded that the duration and quality of analgesia (VAS) were significantly superior and rescue analgesic requirement less in patients who received FNB as compared to IAA.

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Ropivacaine versus Bupivacaine for 3-in-l Block during Total Knee Arthroplasty

Abstract: Ropivacaine and bupivacaine showed similar anesthetic and analgesic effects, but the former had a significantly faster onset time.

Cited by 16 publications

References 25 publications

Analgesia for total knee arthroplasty: a meta-analysis comparing local infiltration and femoral nerve block

Analgesia for total knee arthroplasty: a meta-analysis comparing local infiltration and femoral nerve block

Multimodal nerve injection provides noninferior analgesic efficacy compared with interscalene nerve block after arthroscopic rotator cuff repair

Comparison of intra-articular analgesia and femoral nerve block for postoperative pain relief in unilateral total knee arthroplasty: A randomized clinical study

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