Abstract
Purpose
This dose-response study was designed to determine the most appropriate dose of ropivacaine 0.5% injected via an indwelling femoral catheter for perioperative peripheral analgesia for total knee replacement (TKR).
Methods
84 patients were allocated randomly to four groups and received, via a femoral catheter, either 15, 20, 25 or 30 mL of ropivacaine 0.5% in a double-blind fashion. An anterior sciatic block with 20 mL bupivacaine 0.5% was also performed. The evolution of sensory block of femoral, obturator and lateral femoral cutaneous nerves and motor block of femoral nerve were tested every five minutes during the first 30 min. The percentage of patients with complete sensory block of both femoral and obturator nerves determined success rate. General anesthesia was then induced. After surgery, patient-controlled analgesia (PCA) with ropivacaine 0.2% was available via the femoral catheter. The interval between the initial injection and the first PCA administration determined duration of action.
Results
The duration of action was not different between the four solutions tested i.e., 534 ± 379 min for 15 mL, 799 ± 364 min for 20 mL, 624 ± 342 min for 25 mL and 644 ± 266 min for 30 mL. The percentage of patients with complete sensory femoral and obturator blocks was, respectively, 60%, 95%, 85% and 70% for 15, 20, 25 and 30 mL (P = 0.008/15 mL vs 20 mL).
Conclusion
Although there is no difference in duration of analgesia, because of better sensory spread, 20 mL of ropivacaine 0.5% appears to be the most appropriate dose for peripheral analgesia after TKR.
Objectif
L’étude dose-réponse visait à déterminer la meilleure dose de ropivacaïne à 0,5 % injectée par cathéter fémoral à demeure pour l’analgésie périopératoire périphérique lors d’une arthroplastie totale du genou (ATG).
Méthode
Nous avons réparti au hasard, en quatre groupes, 84 patients qui ont reçu par cathéter fémoral 15, 20, 25 ou 30 mL de ropivacaïne à 0,5 % en double insu. Un bloc sciatique antérieur a aussi été réalisé avec 20 mL de bupivacaïne à 0,5 %. L’évolution du bloc sensitif des nerfs fémoral, obturateur et cutané latéral de la cuisse et du bloc moteur du nerf fémoral a été vérifiée toutes les cinq minutes pendant les 30 premières minutes. Le pourcentage de patients qui présentait un bloc sensitif complet des nerfs fémoral et obturateur a déterminé le taux de succès. L’anesthésie générale a ensuite été induite. Après l’opération, l’analgésie auto-contrôlée (AAC) avec de la ropivacaïne à 0,2 % était disponible par cathéter fémoral. L’intervalle entre l’injection initiale et la première administration d’AAC a donné la durée d’action.
Résultats
La durée d’action a été comparable dans tous les groupes : 534 ± 379 min avec 15 mL, 799 ± 364 min avec 20 mL, 624 ± 342 min avec 25 mL et 644 ± 266 min avec 30 mL. Le pourcentage de patients présentant un bloc sensitif complet des nerfs fémoral et obturateur a été respectivement de 60 %, 95 %, 85 % et 70 % pour les doses de 15, 20, 25 et 30 mL (P = 0,008/15 mL vs20 mL).
Conclusion
Même si la durée de l’analgésie est équivalente, grâce à une meilleure diffusion sensitive, 20 mL de ropivacaïne à 0,5 % semble être la dose la plus appropriée pour l’analgésie périphérique après une ATG.
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Weber, A., Fournier, R., Gamulin, Z. et al. Duration of analgesia is similar when 15, 20, 25 and 30 mL of ropivacaine 0.5% are administered via a femoral catheter. Can J Anesth 52, 390–396 (2005). https://doi.org/10.1007/BF03016282
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DOI: https://doi.org/10.1007/BF03016282