Continuous peripheral nerve blocks: is local anesthetic dose the only factor, or do concentration and volume influence infusion effects as well?

Anesthesiology
Brian M IlfeldScott T Ball

Abstract

The main determinant of continuous peripheral nerve block effects--local anesthetic concentration and volume or simply total drug dose--remains unknown. 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. Quadriceps MVIC for patients receiving 0.1% ropivacaine (n = 26) declined by a mean (SE) of ...Continue Reading

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Citations

Dec 22, 2010·British Journal of Anaesthesia·J E ChellyA Fanelli
Jul 31, 2013·Clinical Orthopaedics and Related Research·Seshadri C MudumbaiEdward R Mariano
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Sep 12, 2015·Current Opinion in Anaesthesiology·Anthony T Machi, Brian M Ilfeld

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