Ultrasound‐guided femoral catheter placement: a randomised comparison of the in‐plane and out‐of‐plane techniques

Abstract

SummaryIn-plane vs out-of-plane needle-probe alignment for perineural catheter placement remains controversial. Patients presenting for major knee surgery were randomly assigned to out-of-plane (n = 42) or in-plane (n = 39) needleprobe alignment for femoral nerve catheter placement, with both techniques using short-axis nerve imaging. Twenty millilitres of ropivacaine 0.5% was administered via the catheter followed by a ropivacaine elastomeric infusion incorporating on-demand boluses. All patients received pre-operative single-injection sciatic and obturator blocks and general anaesthesia. The primary outcome, numerically rated worst pain on movement (0-10) during the first 24 h, demonstrated equivalence within two points of the scale at a 5% significance level using two one-sided tests (corresponding 90% CI À1.2 to 0.6). There were no differences between groups for all secondary outcomes, including numerically rated worst rest pain, ropivacaine bolus and tramadol consumption. These results suggest that for ultrasound-guided femoral catheter placement using short-axis nerve imaging, operators should use the needle-probe alignment technique with which they are most familiar.

Evidence Basis for Ultrasound Guidance for Lower-Extremity Peripheral Nerve Block

“…Since the initial review, there have been 11 additional high-quality RCTs (Jadad scores ≥3) investigating the utility of USG for FNB (Tables 2 and 3) in 1061 patients and 16 volunteers. [10][11][12][13][14][15][17][18][19][20][21] …”

Eficacia analgésica de una dosis única de dexametasona perineural en el bloqueo ecoguiado del nervio femoral en cirugía de prótesis total de rodilla

“…El bloqueo del nervio femoral a dosis única ha demostrado ser útil y eficaz 13,14 para controlar el dolor postoperatorio 15,16 , pero limitado en el tiempo 17 .…”

Use of ultrasound for lower extremity

“…Fredrickson and Danesh-Clough [34] have shown no differences in pain scores, local anesthetic and opioid postoperative consumptions between the two different approaches, suggesting that anesthesiologists should use the needle-probe approach they are more used to.…”