Abstract
BackgroundDuration of peripheral nerve blocks depends on multiple factors. Both technique and type of local anesthetic used, either with or without adjuncts, may result in different duration times of the block. The purpose of the present study was to compare the duration of postoperative analgesia of 30 mL ropivacaine 0.75 % with or without epinephrine for popliteal sciatic nerve block.MethodsThirty-eight patients were included to receive ultrasound guided continuous popliteal nerve block with ropivacaine 0.75 % either without (ROPI) or with epinephrine 5 μg/mL (ROPI-EPI) for ankle fusion, subtalar fusion, or a combination of both. The primary outcome parameter was the duration of postoperative analgesia as reflected by the time to first request for postoperative analgesia (TTFR) through the popliteal nerve catheter. Secondary outcome measures included the onset of sensory and motor block and NRS score for pain at rest and during movement.ResultsThirty patients, 15 in each group, were studied. Eight patients were withdrawn because of specific withdrawal criteria described in the protocol and replaced according to their group allocation. Median [interquartile range] TTFR was 463 [300–1197] min and 830 [397–1128] min for the ROPI vs ROPI-EPI group respectively. Hodges Lehman median difference between groups was 71 min (95 % CI −415 – 473 min). There was no difference in any clinical outcome measure between the groups.ConclusionThe results of this study did not show any significant increase in the duration of postoperative analgesia by adding epinephrine to ropivacaine for popliteal nerve block. This may be due to the intrinsic vasoconstrictive properties of ropivacaine. The absence of a significant difference can also be the result of a type II error caused by a large variation in the individual TTFR.Trial registrationTrial register.nl identifier: NTR3330, keyword TTFR
Highlights
Duration of peripheral nerve blocks depends on multiple factors
In a recent study aimed to describe the pharmacokinetic profile of high dose ropivacaine with and without epinephrine [11], we found an indication of prolonged time to first request for postoperative analgesia (TTFR) after the addition of epinephrine to ropivacaine for combined sciatic/femoral nerve block for anterior cruciate ligament reconstruction
The purpose of the present study is to compare the duration of postoperative analgesia of 30 mL ropivacaine 0.75 % with or without epinephrine for popliteal sciatic nerve block
Summary
Duration of peripheral nerve blocks depends on multiple factors. Both technique and type of local anesthetic used, either with or without adjuncts, may result in different duration times of the block. The purpose of the present study was to compare the duration of postoperative analgesia of 30 mL ropivacaine 0.75 % with or without epinephrine for popliteal sciatic nerve block. Duration of peripheral nerve block depends on several factors such as the choice of local anaesthetic (LA), the site of injection and the presence of adjuncts such as clonidine or epinephrine. In a recent study aimed to describe the pharmacokinetic profile of high dose ropivacaine with and without epinephrine [11], we found an indication of prolonged time to first request for postoperative analgesia (TTFR) after the addition of epinephrine to ropivacaine for combined sciatic/femoral nerve block for anterior cruciate ligament reconstruction. In this study of 12 patients [11], 3 did not request postoperative analgesia (1 in the ROPI-group and 2 in the ROPI-EPI-group). Because of the small number of patients, these data have not been included in the original publication
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