Single-injection femoral nerve block with 0.25% ropivacaine or 0.25% bupivacaine for postoperative analgesia after total knee replacement or anterior cruciate ligament reconstruction

Souza, Rita de Cássia de; Correa, Cláudio Henrique; Henriques, Maurício Delage; Oliveira, Christiano Barbosa de; Nunes, Tarcizo Afonso; Gomez, Renato Santiago

doi:10.1016/j.jclinane.2008.05.016

Cited by 50 publications

(17 citation statements)

References 36 publications

(46 reference statements)

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“…[ 7 ] Femoral nerve block and saphenous nerve block have been proven to provide satisfactory analgesia following knee surgeries. [ 8 9 ] Although the primary innervation of the knee is by the femoral nerve, it also receives contributions from the obturator nerve, lateral cutaneous nerve and sciatic nerve. Hence, we used 3-in-1 block that blocks the femoral nerve, lateral cutaneous nerve and obturator nerve in our study.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of magnesium as an adjuvant to bupivacaine in 3-in-1 nerve block for arthroscopic anterior cruciate ligament repair

et al. 2016

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Background and Aims:Three-in-one and femoral nerve blocks are proven modalities for postoperative analgesia following anterior cruciate ligament (ACL) reconstruction. The aim of this study was to evaluate the efficacy of magnesium (Mg) as an adjuvant to bupivacaine in 3-in-1 block for ACL reconstruction.Methods:Sixty patients undergoing arthroscopic ACL reconstruction were randomly allocated to Group I (3-in-1 block with 30 ml of 0.25% bupivacaine preceded by 1.5 ml of intravenous [IV] saline), Group II (3-in-1 block with 30 ml of 0.25% bupivacaine preceded by 1.5 ml of solution containing 150 mg Mg IV) or Group III (3-in-1 block with 30 ml containing 0.25% bupivacaine and 150 mg of Mg as adjuvant preceded by 1.5 ml of IV saline). Post-operatively, patients received morphine when visual analogue scale (VAS) score was ≥4. Quantitative parameters were compared using one-way ANOVA and Kruskal–Wallis test and qualitative data were analysed using Chi-square test.Results:Demographics, haemodynamic parameters, intra-operative fentanyl requirement, post-operative VAS scores and total morphine requirement were comparable between groups. Time to first analgesic requirement was significantly prolonged in Group III (789 ± 436) min compared to Group I (466 ± 290 min) and Group II (519 ± 274 min), (P = 0.02 and 0.05). Significantly less number of patients in Group III (1/20) received morphine in the first 6 h post-operatively, compared to Group I (8/20) and Group II (6/20) (P = 0.008 and 0.03). No side effects were observed.Conclusion:Mg as an adjuvant to bupivacaine in 3-in-1 block for ACL reconstruction significantly prolongs the time to first analgesic requirement and reduces the number of patients requiring morphine in the immediate post-operative period.

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Section: Discussionmentioning

confidence: 99%

Efficacy of magnesium as an adjuvant to bupivacaine in 3-in-1 nerve block for arthroscopic anterior cruciate ligament repair

et al. 2016

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“…The authors of five of these studies reported the reasons for their decision (Table 3). One group of authors stated that they were refused ethics approval to use an invasive placebo for a femoral nerve block trial [62], whereas several studies using the same placebo nerve block were given ethics committee approval [42, 81]. It seems that ethics committees do not have a uniform approach to risk.…”

Section: Discussionmentioning

confidence: 99%

Use of invasive placebos in research on local anaesthetic interventions

McGuirk¹,

Fahy²,

Costi³

et al. 2011

Anaesthesia

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Placebos play a vital role in clinical research, but their invasive use in the context of local anaesthetic blocks is controversial. We assessed whether recently published randomised controlled trials of local anaesthetic blocks risked harming control group patients in contravention of the Declaration of Helsinki. We developed the 'SHAM' (Serious Harm and Morbidity) scale to assess risk: grade 0 = no risk (no intervention); grade 1 = minimal risk (for example, skin allergy to dressing); grade 2 = minor risk (for example, subcutaneous haematoma, infection); grade 3 = moderate risk (with or without placebo injection) (for example, neuropraxia); and grade 4 = major risk (such as blindness, pneumothorax, or liver laceration). Placebo interventions of the 59 included trials were given a SHAM grade. Nine hundred and nineteen patients in 31 studies, including six studies with 183 children, received an invasive placebo assessed as SHAM grade ‡ 3. A high level of agreement (78%, j = 0.80, p < 0.001) for SHAM grades 0-4 increased to 100% following discussion between assessors. More than half of the randomised controlled study designs subjected patients in control groups to risks of serious or irreversible harm. A debate on whether it is justifiable to expose control group patients to risks of serious harm is overdue.

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“…6 Bupivacaine versus ropivacaine showed similar efficacy in SSFNB with or without a single-shot sciatic nerve block. 7–9 As might be predicted, a local anesthetic injection decreases pain for the expected duration of the anesthetic and most studies examine acute postoperative pain up to 24–48 hours after surgery. With single injections, this effect did not appear to persist beyond postoperative care unit (PACU) discharge, 10,11 although opioid use was shown to be decreased up to 48 hours after the injection in elderly patients.…”

Section: Resultsmentioning

confidence: 99%

Preventive Analgesia by Local Anesthetics

Barreveld

Witte

Chahal³

et al. 2013

Anesthesia &Amp; Analgesia

142

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The use of local anesthetics to reduce acute postoperative pain has a long history, but recent reports have not been systematically reviewed. In addition, the need to include only those clinical studies that meet minimum standards for randomization and blinding must be adhered to. In this review we have applied stringent clinical study design standards to identify publications on the use of perioperative local anesthetics. We first examined several types of peripheral nerve blocks, covering a variety of surgical procedures, and second, for effects of intentionally administered IV local anesthetic (lidocaine) for suppression of postoperative pain. Thirdly, we have examined publications in which vascular concentrations of local anesthetics were measured at different times after peripheral nerve block procedures, noting the incidence when those levels reached ones achieved during intentional IV administration. Importantly, the very large number of studies using neuraxial blockade techniques (epidural, spinal) has not been included in this review but will be dealt with separately in a later review. The overall results showed a strongly positive effect of local anesthetics, by either route, for suppressing postoperative pain scores and analgesic (opiate) consumption. In only a few situations were the effects equivocal. Enhanced effectiveness with the addition of adjuvants was not uniformly apparent. The differential benefits between drug delivery before, during, or immediately after a surgical procedure are not obvious, and a general conclusion is that the significant antihyperalgesic effects occur when the local anesthetic is present during the acute postoperative period, and its presence during surgery is not essential for this action.

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Single-injection femoral nerve block with 0.25% ropivacaine or 0.25% bupivacaine for postoperative analgesia after total knee replacement or anterior cruciate ligament reconstruction

Cited by 50 publications

References 36 publications

Efficacy of magnesium as an adjuvant to bupivacaine in 3-in-1 nerve block for arthroscopic anterior cruciate ligament repair

Efficacy of magnesium as an adjuvant to bupivacaine in 3-in-1 nerve block for arthroscopic anterior cruciate ligament repair

Use of invasive placebos in research on local anaesthetic interventions

Preventive Analgesia by Local Anesthetics

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