The efficacy of simultaneous bilateral axillary brachial plexus block under the guidance of neurostimulator or ultrasound: a prospective study.

PURPOSE: This study was designed to investigate the risk of local anesthetic toxicity and efficacy of simultaneous bilateral axillary brachial plexus block performed under the guidance of ultrasound or a neurostimulator. METHODS: One hundred and twenty patients who were anesthetized with bilateral axillary plexus block simultaneously between February 2012 and March 2014 were enrolled in the study. The patients were anesthetized under the guidance of a neurostimulator (group N, n = 60) or ultrasound (group U, n = 60). The block performance time, procedure-related pain, adverse events, total and free plasma concentrations of ropivacaine, and other data were recorded. The comparison was analyzed statistically. RESULTS: The block performance time, and onset of the sensory and motor block, of group N was longer than that of group U (p < 0.001). The procedure-related pain of group N was more serious than that of group U (p < 0.05). The patient satisfaction rate of group U was higher than that of group N (p < 0.05). The total plasma concentrations of ropivacaine in group N were comparable to those of group U, except for the value at 50 min after injection (p < 0.05). The free plasma concentrations of ropivacaine of group N at 5 min were significantly higher than that of group U (p < 0.001). No apparent serious adverse events were observed perioperatively in both groups. CONCLUSIONS: Simultaneous bilateral axillary brachial plexus block guided by neurostimulator or ultrasound in bilateral distal upper extremity surgery seems to have a low risk of local anesthetic toxicity and to be effective. The ultrasound-guided block is superior in terms of providing the same degree of anesthesia with shorter duration, less pain, and faster onset of sensory and motor blockades, which is important in clinical practice.

[Comparing the analgesic efficacy of continuous femoral nerve blockade and continuous intravenous analgesia after total knee arthroplasty].

OBJECTIVE: To compare the analgesic efficacy of continuous femoral nerve blockade (CFNB) and continuous intravenous analgesia (CIA) after total knee arthroplasty (TKA). METHODS: 126 patients undergoing TKA under combined epidural-spinal anesthesia were randomized to receive either a femoral infusion of ropivacaine 0.2% (median infusion rate 5 ml/h) (n = 63) or an intravenous infusion of fentanyl 30 µg/kg (2 ml/h) (n = 63). Adjuvant analgesics were oral celebrex or IM pethidine. In the CFNB group, CFNB was established before combined epidural-spinal anesthesia and 20 ml 0.5%ropivacaine was infused through the catheter placed near femoral nerve. Visual analogue scale (VAS) scores were assessed at rest and on passive mobilization by acute pain service blinded to analgesic treatment. Nausea and vomiting, dizziness, satisfaction and other side-effects were assessed postoperatively. RESULTS: There was significantly less VAS scores in the CFNB group comparing the CIA group at rest 4, 8, 12, 16, 24, 36, 48 h after surgery (P < 0.01). A significant difference in VAS scores was found in CFNB group vs CIA group on passive mobilization 24, 36, 48 h after operation (P < 0.01). There was significantly less dizziness, nausea and vomiting in the CFNB group (P < 0.01). Patient satisfaction was higher in the CFNB group (92.1%) than the CIA group (20.6%) (P < 0.01). CONCLUSION: CFNA with ropivacaine 0.2% is more effective in controlling postoperative pain than CIA and CFNB is an effective regional component of a multimodal analgesic strategy after TKA.