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

scholarly journals The Effects of Varying Local Anesthetic Concentration and Volume on Continuous Popliteal Sciatic Nerve Blocks: A Dual-Center, Randomized, Controlled Study

2008 ◽  
Vol 107 (2) ◽  
pp. 701-707 ◽  
Author(s):  
Brian M. Ilfeld ◽  
Vanessa J. Loland ◽  
J C. Gerancher ◽  
Anupama N. Wadhwa ◽  
Elizabeth M. Renehan ◽  
...  
Keyword(s):  
Sciatic Nerve ◽  
Local Anesthetic ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Nerve Blocks ◽  
Randomized Controlled ◽  
Anesthetic Concentration

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.

Effects of Local Anesthetic Concentration and Dose on Continuous Interscalene Nerve Blocks

2008 ◽  
Vol 33 (6) ◽  
pp. 518-525
Author(s):  
Linda T. Le ◽  
Vanessa J. Loland ◽  
Edward R. Mariano ◽  
J. C. Gerancher ◽  
Anupama N. Wadhwa ◽  
...  
Keyword(s):  
Local Anesthetic ◽  
Nerve Blocks ◽  
Continuous Interscalene ◽  
Anesthetic Concentration

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 Randomized Study of the Effect of Initial Ropivacaine Dosage during Continuous Popliteal Nerve Blocks on Rebound Pain in Foot and Ankle Surgery

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0006
Author(s):  
Ryan Rogero ◽  
Elizabeth McDonald ◽  
Steven M. Raikin ◽  
Daniel Fuchs ◽  
Rachel J. Shakked ◽  
...  
Keyword(s):  
Side Effects ◽  
Postoperative Pain ◽  
Pain Score ◽  
Local Anesthetic ◽  
Pain Control ◽  
Foot And Ankle ◽  
Nerve Blocks ◽  
Anesthetic Concentration ◽  
Ankle Surgery ◽  
Perceived Pain

Category: Basic Sciences/Biologics, Anesthesia/Pain Control Introduction/Purpose: Rebound pain, the quantifiable difference in pain experienced after nerve block resolution, can be a substantial component of postoperative pain, opioid intake, sleep disturbances, and patient satisfaction. A relatively higher concentration initial local anesthetic bolus may contribute to this phenomenon, as the transition from an entirely numb and painless limb to a partially numb limb may lead to greater perceived pain following block resolution. In contrast, patients experiencing some level of background pain immediately following surgery due to a lower concentration initial bolus may have less perceived pain after block resolution. The purpose of this study is to evaluate the influence of the initial local anesthetic concentration in continuous popliteal nerve blocks on rebound pain and other postoperative variables in foot and ankle surgery. Methods: Following IRB approval, patients undergoing outpatient foot and ankle procedures requiring continuous popliteal nerve blocks under the care of a single fellowship-trained foot & ankle surgeon were identified. Subjects were randomized and blinded to either the standard (0.5%) or low-dose (0.2%) initial ropivacaine bolus, both being followed by a continuous 0.2% ropivacaine catheter infusion. From postoperative days 1 to 7, subjects recorded their hourly visual analog scale (VAS) pain level out of 100, perceived pain relief from the block, and satisfaction with pain control, as well as daily narcotic intake and other postoperative side effects, through an electronic survey. Rebound pain was scored according to a published method by subtracting the lowest VAS pain score during the 12 hours prior to the subject’s determination of block resolution from the highest VAS pain score in the 12 hours after resolution. 69 subjects completed the study. Outcomes were compared using Student’s t-tests. Results: Thirty-four subjects received a standard initial 0.5% ropivacaine bolus, while 35 received a 0.2% bolus. Chi-square testing and t-tests revealed no difference in any preoperative patient variables or procedural type/location between groups. Subjects receiving the lower 0.2% ropivacaine bolus had a lower rebound pain score (47.6) than those receiving the standard ropivacaine bolus (51.0), though not significantly (p=.679). The group receiving the lower concentration bolus only reported a higher mean VAS pain at 72 hours following surgery (39.6 vs. 25.7, p=.044) and more pain interference with sleep (p=.015) on postoperative day 5. The groups did not differ significantly (p>.05) on any day in terms of morphine equivalent units (MEUs) consumed, satisfaction with pain control, nausea, constipation, or nerve-related symptoms of tingling, numbness, and hypersensitivity. Conclusion: The utilization of a lower concentration initial local anesthetic bolus in continuous peripheral nerve blocks in foot and ankle surgery did not significantly lower rebound pain, but provided similar postoperative pain control as a standard local anesthestic bolus concentration. Further investigation with larger cohorts is needed to further optimize local anesthetic concentration in continuous nerve blocks in order to limit postoperative pain, side effects, and opioid intake following foot and ankle surgery.

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