Abstract
Purpose
To test the hypothesis that the addition of a preincisional femoral 3-in-1 block to intra-articular instillation with ropivacaine 0.2% at the end of surgery improves postoperative pain control in patients undergoing arthroscopic anterior cruciate ligament reconstruction (ACLR) under general anesthesia.
Methods
In a prospective, randomized, placebo-controlled, double-blind trial, we studied 44 patients scheduled for inpatient ACLR. Prior to incision, the treatment group (n = 22) received a femoral 3-in-1 block with 40 ml ropivacaine 0.2%, augmented by infiltrations of the lateral and anteromedial incisions with 20 ml ropivacaine 0.2% at the end of the procedure. The control group (n = 22) received saline 0.9% instead of ropivacaine. All patients received an intra-articular instillation with 30 ml ropivacaine 0.2% at the end of surgery. The primary efficacy variable was 24 hr morphine consumption postoperatively standardized by weight, administered intravenously via a patient-controlled analgesia (PCA) pump.
Results
There was no difference between both groups in 24 hr PCA morphine consumption postoperatively (control, 0.45 ± 0.44 [mean ± SD] mg·kg−1; treatment, 0.37 ± 0.50 mg·kg−1; P = 0.55). No difference was found in postoperative visual analog scale pain scores, adverse events, or vital signs. In the treatment group, R = 10/22 patients did not require postoperative morphine compared with R = 6/22 in the control group (P = 0.35).
Conclusion
We found no effect of a femoral 3-in-1 block with ropivacaine 0.2% on postoperative analgesic consumption, compared to intra-articular instillation with ropivacaine 0.2% alone, in patients undergoing ACLR under general anesthesia.
Résumé
Objectif
Vérifier l’hypothèse selon laquelle l’addition, avant l’incision, d’un blocage fémoral 3 en I à l’instillation intra- articulaire de ropivacaïne 0,2% de fin d’opération, améliore le soulagement de la douleur postopératoire chez les patients qui subissent une reconstruction arthroscopique du ligament croisé antéro-externe (RLCA) sous anesthésie générale.
Méthode
Il s’agit d’un essai prospectif randomisé en double insu contre placebo concernant 44 patients qui subissent une RLCA élective en chirurgie ambulatoire. Avant l’incision, le groupe traité (n = 22) a reçu un bloc fémoral 3 en I de 40 ml de ropivacaïne 0,2%, augmenté par des infiltrations des incisions latérale et antéromédiane de 20 ml de ropivacaine 0,2% à la fin de l’intervention. Le groupe témoin (n = 22) a reçu une solution salée à 0,9%. Tous les patients ont reçu une instillation intra-articulaire de 30 ml de ropivacaine 0,2% à la fin de l’opération. La principale variable d’efficacité a été la demande de morphine postopératoire à 24 h, uniformisée selon le poids, dont l’administration intraveineuse s’est faite à l’aide d’une pompe d’analgésie contrôlée par le patient (ACP).
Résultats
La demande postopératoire de morphine ACP à 24 h n’a pas présenté de différence intergroupe (témoin, 0,45 ± 0,44 [moyenne ± écart type]mg·kg−1; traitement, 0,37 ± 0,50 mg·kg−1; P = 0,55), ni les seuils de douleur postopératoire, selon l’échelle visuelle analogue, les effets secondaires et les signes vitaux. Dans le groupe de traitement, 10/22 patients n’ont pas demandé de morphine postopératoire et 6/22 dans le groupe témoin (P = 0,35).
Conclusion
Nous n’avons pas noté d’effet du blocage fémoral 3 en I de ropivacaïne 0,2% sur la demande postopératoire d’analgésique, comparé à l’instillation intra-articulaire de ropivacaïne 0,2% seule, chez des patients qui subissent une RLCA sous anesthésie générale.
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Supported by a grant from Astra Canada. Dr. Schwarz is recipient of a Medical Research Council of Canada (MRC) Fellowship.
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Schwarz, S.K.W., Franciosi, L.G., Ries, C.R. et al. Addition of femoral 3-in-1 blockade to intra-articular ropivacaine 0.2% does not reduce analgesic requirements following arthroscopic knee surgery. Can J Anesth 46, 741–747 (1999). https://doi.org/10.1007/BF03013909
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DOI: https://doi.org/10.1007/BF03013909