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Canadian Journal of Anesthesia

, 48:1102 | Cite as

Intraoperative single-shot “3-in-1” femoral nerve block with ropivacaine 0.25%, ropivacaine 0.5% or bupivacaine 0.25% provides comparable 48-hr analgesia after unilateral total knee replacement

  • Huey Ping
  • Keng Fatt CheongEmail author
  • Aymeric Lim
  • Jui Lim
  • Mark E. Puhaindran
Regional Anesthesia and Pain

Abstract

Purpose

To compare analgesia after intraoperative single shot “3-in-1” femoral nerve block (FNB) in combination with general anesthesia using ropivacaine 0.25%, ropivacaine 0.5% with bupivacaine 0.25% for total knee replacement (TKR).

Methods

We performed a randomized, double-blind study in 48 patients for elective TKR under general anesthesia. Patients were randomized to one of four groups (C: sham block, R1: “3-in-1” FNB using 30 mL of ropivacaine 0.25%, R2: “3-in-1 ” FNB using 30 mL of ropivacaine 0.5%, B: “3-in-1” FNB using 30 mL of bupivacaine 0.25%). Verbal pain score (VPS) both at rest and movement were assessed for 48 hr after TKR (0 = none; 1 =mild; 2 = moderate; 3=severe). Total morphine consumption and its associated side effects, duration of hospitalization after operation were also compared.

Results

There were no differences in patients’ physical characteristics, intraoperative morphine usage, operation time, tourniquet time or length of hospitalization between the four groups. When compared with group C, the VPS was significantly lower in groups R1, R2 and B at one, four, eight, 24 and 48 hr after TKR(P < 0.05). The morphine requirement of groups R1, R2 and B were also significantly lower when comparing with group C up to 48 hr postoperatively (P < 0.05). There were no significant differences in VPS and postoperative morphine requirement at any time between groups R1, R2 and B.

Conclusion

“3-in-1” FNB with ropivacaine provided analgesia that was clinically comparable to that of bupivacaine up to 48 hr after TKR. Increasing the concentration of ropivacaine from 0.25% to 0.5% failed to improve the postoperative analgesia of “3-in-1” FNB.

Keywords

Morphine Bupivacaine Ropivacaine Femoral Nerve Block Tourniquet Time 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Le blocage peropératoire “3 en 1” du nerf fémoral par une dose unique de ropivacaïne à 0,25 % ou à 0,5 % ou de bupivacaïne à 0,25 % produit une analgésie de 48 h comparable après la mise en place d’une prothèse totale de genou

Résumé

Objectif

Comparer l’analgésie fournie par l’administration peropératolre d’un bloc “3 en 1” du nerf fémoral (BNF) en une dose unique, combinée à l’anesthésle générale, avec de la ropivacaïne à 0,25 %, ou à 0,5 %, ou de la bupivacaïne à 0,25 % pour la mise en place d’une prothèse totale de genou (PTG).

Méthode

L’étude randomisée et à double Insu comprend 48 patients qui reçoivent une PTG non urgente sous anesthésie générale. On forme quatre groupes (T: groupe témoin avec bloc fictif, R1: BNF “3 en 1” avec 30 mL de roplvacaïne à 0,25 %, R2: BNF “3 en 1” avec 30 mL de roplvacaïne à 0,5 %, B: BNF “3 en 1” avec 30 mL de bupivacaïne à 0,25 %). Les scores de l’échelle verbale de douleur (EVD) au repos et pendant le mouvement sont notés pendant 48 h après la PTG (0 = aucune; 1 = légère; 2 = modérée; 3 = sévère). La consommation totale de morphine et ses effets secondaires et la durée de l’hospitalisation postopératoire sont comparés.

Résultats

Les caractéristiques physiques des patients, la consommation de morphine peropératolre, la durée de l’intervention, le temps de garrot ou la durée de l’hospitalisation sont comparables dans les quatre groupes. Comparé à celui du groupe T, le score à l’EVD des groupes R1, R2 et B est slgnlfcatlvement plus bas à une, quatre, huit, 24 et 48 h après la PTG (P < 0,05). Les besoins de morphine dans les groupes R1, R2 et B sont aussi slgnlfcatlvement plus bas que ceux du groupe C jusqu’à 48 h après l’opération (P < 0,05). Les scores EVD et la consommation de morphine postopératoire demeurent comparables en tout temps dans les groupes R1, R2 et B.

Conclusion

Le BNF “3 en 1” avec de la roplvacaïne fournit une analgésie expérimentale comparable à celle de la bupivacaïne jusqu’à 48 h après une PTG. L’augmentation de la concentration de roplvacame de 0,25 % à 0,5 % ne permet pas d’améliorer l’analgésie postopératoire du BNF “3 en 1”.

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Copyright information

© Canadian Anesthesiologists 2001

Authors and Affiliations

  • Huey Ping
    • 1
  • Keng Fatt Cheong
    • 1
    Email author
  • Aymeric Lim
    • 2
  • Jui Lim
    • 1
  • Mark E. Puhaindran
    • 1
  1. 1.Department of AnaesthesiologyNational University HospitalSingapore
  2. 2.Hand and Reconstructive SurgeryNational University HospitalSingapore

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