scholarly journals Continuous Femoral Nerve Blocks

2012 ◽  
Vol 116 (3) ◽  
pp. 665-672 ◽  
Author(s):  
Maria Bauer ◽  
Lu Wang ◽  
Olusegun K. Onibonoje ◽  
Chad Parrett ◽  
Daniel I. Sessler ◽  
...  
Keyword(s):  
Local Anesthetic ◽  
Isometric Contraction ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Electrical Current ◽  
Quadriceps Tendon ◽  
Nerve Blocks ◽  
Maximum Voluntary Isometric Contraction ◽  
Anesthetic Concentration ◽  
Secondary Endpoints

Background Whether decreasing the local anesthetic concentration during a continuous femoral nerve block results in less quadriceps weakness remains unknown. Methods Preoperatively, bilateral femoral perineural catheters were inserted in subjects undergoing bilateral knee arthroplasty (n = 36) at a single clinical center. Postoperatively, right-sided catheters were randomly assigned to receive perineural ropivacaine of either 0.1% (basal 12 ml/h; bolus 4 ml) or 0.4% (basal 3 ml/h; bolus 1 ml), with the left catheter receiving the alternative concentration/rate in an observer- and subject-masked fashion. The primary endpoint was the maximum voluntary isometric contraction of the quadriceps femoris muscles the morning of postoperative day 2. Equivalence of treatments would be concluded if the 95% CI for the difference fell within the interval -20%-20%. Secondary endpoints included active knee extension, passive knee flexion, tolerance to cutaneous electrical current applied over the distal quadriceps tendon, dynamic pain scores, opioid requirements, and ropivacaine consumption. Results Quadriceps maximum voluntary isometric contraction for limbs receiving 0.1% ropivacaine was a mean (SD) of 13 (8) N · m, versus 12 (8) N · m for limbs receiving 0.4% [intrasubject difference of 3 (40) percentage points; 95% CI -10-17; P = 0.63]. Because the 95% CI fell within prespecified tolerances, we conclude that the effect of the two concentrations were equivalent. Similarly, there were no statistically significant differences in secondary endpoints. Conclusions For continuous femoral nerve blocks, we found no evidence that local anesthetic concentration and volume influence block characteristics, suggesting that local anesthetic dose (mass) is the primary determinant of perineural infusion effects.

scholarly journals Continuous Femoral Nerve Blocks

2011 ◽  
Vol 115 (4) ◽  
pp. 774-781 ◽  
Author(s):  
Matthew T. Charous ◽  
Sarah J. Madison ◽  
Preetham J. Suresh ◽  
NavParkash S. Sandhu ◽  
Vanessa J. Loland ◽  
...  
Keyword(s):  
Local Anesthetic ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Quadriceps Tendon ◽  
Significant Degree ◽  
Contralateral Side ◽  
Nerve Blocks ◽  
Maximum Voluntary Isometric Contraction ◽  
Cutaneous Sensation ◽  
Secondary Endpoints

Background Whether the method of local anesthetic administration for continuous femoral nerve blocks--basal infusion versus repeated hourly bolus doses--influences block effects remains unknown. Methods Bilateral femoral perineural catheters were inserted in volunteers (n = 11). Ropivacaine 0.1% was concurrently administered through both catheters: a 6-h continuous 5 ml/h basal infusion on one side and 6 hourly bolus doses on the contralateral side. The primary endpoint was the maximum voluntary isometric contraction (MVIC) of the quadriceps femoris muscle at hour 6. Secondary endpoints included quadriceps MVIC at other time points, hip adductor MVIC, and cutaneous sensation 2 cm medial to the distal quadriceps tendon in the 22 h after initiation of local anesthetic administration. Results Quadriceps MVIC for limbs receiving 0.1% ropivacaine as a basal infusion declined by a mean (SD) of 84% (19) compared with 83% (24) for those receiving 0.1% ropivacaine as repeated bolus doses between baseline and hour 6 (paired t test P = 0.91). Intrasubject comparisons (left vs. right) also reflected a lack of difference: the mean basal-bolus difference in quadriceps MVIC at hour 6 was -1.1% (95% CI -22.0-19.8%). The similarity did not reach the a priori threshold for concluding equivalence, which was the 95% CI decreasing within ± 20%. There were similar minimal differences in the secondary endpoints during local anesthetic administration. Conclusions This study did not find evidence to support the hypothesis that varying the method of local anesthetic administration--basal infusion versus repeated bolus doses--influences continuous femoral nerve block effects to a clinically significant degree.

scholarly journals Continuous Peripheral Nerve Blocks

2010 ◽  
Vol 112 (2) ◽  
pp. 347-354 ◽  
Author(s):  
Brian M. Ilfeld ◽  
Lisa K. Moeller ◽  
Edward R. Mariano ◽  
Vanessa J. Loland ◽  
Jennifer E. Stevens-Lapsley ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Nerve Block ◽  
Local Anesthetic ◽  
Femoral Nerve ◽  
Lumbar Plexus ◽  
Nerve Blocks ◽  
Maximum Voluntary Isometric Contraction ◽  
Ambulatory Ability ◽  
Anesthetic Concentration ◽  
Secondary Endpoints

Background The main determinant of continuous peripheral nerve block effects--local anesthetic concentration and volume or simply total drug dose--remains unknown. Methods We compared two different concentrations and basal rates of ropivacaine--but at equivalent total doses--for continuous posterior lumbar plexus blocks after hip arthroplasty. Preoperatively, a psoas compartment perineural catheter was inserted. Postoperatively, patients were randomly assigned to receive perineural ropivacaine of either 0.1% (basal 12 ml/h, bolus 4 ml) or 0.4% (basal 3 ml/h, bolus 1 ml) for at least 48 h. Therefore, both groups received 12 mg of ropivacaine each hour with a possible addition of 4 mg every 30 min via a patient-controlled bolus dose. The primary endpoint was the difference in maximum voluntary isometric contraction (MVIC) of the ipsilateral quadriceps the morning after surgery, compared with the preoperative MVIC, expressed as a percentage of the preoperative MVIC. Secondary endpoints included hip adductor and hip flexor MVIC, sensory levels in the femoral nerve distribution, hip range-of-motion, ambulatory ability, pain scores, and ropivacaine consumption. Results Quadriceps MVIC for patients receiving 0.1% ropivacaine (n = 26) declined by a mean (SE) of 64.1% (6.4) versus 68.0% (5.4) for patients receiving 0.4% ropivacaine (n = 24) between the preoperative period and the day after surgery (95% CI for group difference: -8.0-14.4%; P = 0.70). Similarly, the groups were found to be equivalent with respect to secondary endpoints. Conclusions For continuous posterior lumbar plexus blocks, local anesthetic concentration and volume do not influence nerve block characteristics, suggesting that local anesthetic dose (mass) is the primary determinant of perineural infusion effects.

scholarly journals The Effects of Local Anesthetic Concentration and Dose on Continuous Infraclavicular Nerve Blocks: A Multicenter, Randomized, Observer-Masked, Controlled Study

2009 ◽  
Vol 108 (1) ◽  
pp. 345-350 ◽  
Author(s):  
Brian M. Ilfeld ◽  
Linda T. Le ◽  
Joanne Ramjohn ◽  
Vanessa J. Loland ◽  
Anupama N. Wadhwa ◽  
...  
Keyword(s):  
Local Anesthetic ◽  
Controlled Study ◽  
Nerve Blocks ◽  
Anesthetic Concentration

Analgesia and anaesthesia

2020 ◽  
pp. 281-327
Author(s):  
Jonathan P. Wyatt ◽  
Robert G. Taylor ◽  
Kerstin de Wit ◽  
Emily J. Hotton ◽  
Robin J. Illingworth ◽  
...  
Keyword(s):  
Emergency Department ◽  
Nerve Block ◽  
Local Anaesthetic ◽  
Local Anaesthesia ◽  
Femoral Nerve Block ◽  
Rapid Sequence Induction ◽  
Femoral Nerve ◽  
General Anaesthetic ◽  
Intravenous Sedation ◽  
Nerve Blocks

This chapter in the Oxford Handbook of Emergency Medicine investigates analgesia and anaesthesia in the emergency department (ED). It looks at options for relieving pain, such as the analgesics aspirin, paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), morphine and other opioids, Entonox®, and ketamine, and explores analgesia for trauma and other specific situations. It discusses local anaesthesia (LA) and local anaesthetic toxicity, including use of adrenaline (epinephrine) and general principles of local anaesthesia. It explores blocks such as Bier’s block, local anaesthetic nerve blocks, intercostal nerve block, digital nerve block, median and ulnar nerve blocks, radial nerve block at the wrist, dental anaesthesia, nerve blocks of the forehead and ear, fascia iliaca compartment block, femoral nerve block, and nerve blocks at the ankle. It examines sedation, including drugs for intravenous sedation and sedation in children, and discusses general anaesthesia in the emergency department, emergency anaesthesia and rapid sequence induction, difficult intubation, and general anaesthetic drugs.

scholarly journals Defining the minimal effective volume and amount of lidocaine to perform a femoral nerve block under ultrasound control

2020 ◽  
Author(s):  
Valery Piacherski ◽  
Aliaksei Marachkou
Keyword(s):  
Sciatic Nerve ◽  
Nerve Block ◽  
Local Anesthetics ◽  
Peripheral Nerves ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
The Body ◽  
Effective Volume ◽  
Nerve Blocks ◽  
Nerve Blockade

Abstract BackgroundThe application of the combination of local anesthetics (LA) in some parts of the body increases the amount of LA and plasma concentration. The aim of our research was to define the minimal effective volume and amount of lidocaine with added adrenaline (1:200,000) to perform a femoral nerve block under ultrasound control and with neurostimulation. MethodsFemoral nerve blockade was performed with the following lidocaine solutions: 0.75% -10 ml, 7.5 ml; 1% -20ml, 15ml, 10ml, 7.5ml, 5ml; 1.5% -5ml, 4ml; 2% -5 ml, 4 ml; 3% -5ml, 4ml, 3ml; 4% -5 ml, 4 ml, 3 ml, 2.5 ml. All blocks were performed with added adrenaline (1:200,000). In all, 181 blocks of the femoral nerve, in combination with sciatic nerve blocks, were carried out with the help of the electrostimulation of peripheral nerves, and under ultrasound. The quality of motor and sensory blocks was assessed after 45 min of administration of the femoral nerve block. ResultsA total of 181 femoral nerve blocks, in combination with sciatic nerve blocks, were used via the help of electrostimulation of the peripheral nerves (EPN), and under ultrasound (US) control. The femoral nerve blockade was effective with the following lidocaine solutions: 0.75% -10 ml (75mg); 1% -20ml, 15ml, 10ml, 7.5ml (75mg); 1.5% -5ml (75mg); 2% -5 ml (100 mg); 3% -5ml (150mg); 4% -5 ml (200mg). Femoral blockade was ineffective when using the following solutions of lidocaine: 0.75% - 7.5ml (56.25 mg); 1% - 5ml (50mg); 1.5% - 4ml (60mg, No spread along the entire circumference of the nerve - NSAECN); 2% - 4 ml (80mg, NSAECN); 3% - 4ml (120mg NSAECN), 3 ml; 4% - 4 ml (160 mg, NSAECN), 3 ml, 2.5 ml. ConclusionFor a complete motor and sensory block of the femoral nerve: the minimum effective volume of local anesthetics was 5 ml; and the minimum effective amount of lidocaine was 75 mg. А complete block of the femoral nerve was achieved only with the spreading of local anesthetic along the whole circumference of the femoral nerve.

scholarly journals Ultrasound-Guided Sciatic and Femoral Block in Patient with Recent Embolism Stroke Undergo Amputation Above the Knee

2021 ◽  
Vol 2 (3) ◽  
pp. 116-119
Author(s):  
Propan Hanggada Satyamakti Mubarak ◽  
Keyword(s):  
Peripheral Nerve ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Lower Extremities ◽  
Major Surgery ◽  
Anesthetic Technique ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
The Right

Background: Patients undergoing amputation of the lower extremities usually have poor circulation and other comorbidities and, therefore, present a challenge to the anesthesiologist. The combination of sciatic and femoral nerve block is reported to be an effective anesthetic technique for patients undergoing knee surgery, and it is known to be an effective method of postoperative analgesia in patients undergoing major surgery on the subject's lower extremities. Case: A 70-year-old man with a recent embolism stroke, death of his limb on the right cruris region, and underwent an amputation above the knee. Preoperative physical examination showed GCS E4 V, motor aphasia M6, blood pressure 131/82 mmHg, pulse 114 bpm, RR 20 times/minute with bodyweight 70 kg, height 160 cm, SpO2 97%. There was cyanosis in the right cruric region with motor power of 1/5 1/5. The value of leukocytes 18,600/ul, platelets 309,000/ul, Prothrombin Time (PT) 15.8 seconds, Activated partial thromboplastin time (APTT) 25.9 seconds, International normalized ratio (INR) 1,330, neutrophils 81.7%, lymphocytes 12.6%, creatinine 1.8 mg/dl, urea 137 mg /dl, blood sugar at the time 258 mg/dl, Cl 95 mmol/l. This case report suggests that ultrasound-guided peripheral nerve blocks may be useful for major lower extremity surgery in patients with severe hemodynamic impairment. Conclusion: Perioperative management of embolism stroke patients undergoing above-knee amputation requires special attention in selecting anesthetics. Ultrasound-guided peripheral nerve blocks minimize patient hemodynamic changes and provide better postoperative pain control.

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