Nerve stimulator versus ultrasound guidance for placement of popliteal catheters for foot and ankle surgery.
J Clin Anesth
; 24(1): 44-50, 2012 Feb.
Article
in En
| MEDLINE
| ID: mdl-22284318
ABSTRACT
STUDY OBJECTIVE:
To determine whether ultrasound guidance improves the quality of continuous popliteal block when compared with a nerve stimulator after major foot and ankle surgery.DESIGN:
Prospective, randomized, double-blinded clinical trial.SETTING:
Operating room, Postanesthesia Care Unit (PACU), and hospital wards of a university-affiliated hospital. PATIENTS 45 ASA physical status 1, 2, and 3 patients undergoing elective major foot and ankle surgery.INTERVENTIONS:
Placement of a popliteal sciactic nerve catheter using either nerve stimulator or ultrasound guidance. In the PACU, a continuous infusion of ropivacaine 0.2% was started at a basal rate of 4 mL/hr and adjusted in a standardized fashion to maintain visual analog scale (VAS) pain scores < 4. All patients also received intravenous (IV) patient-controlled analgesia with hydromorphone and oral opioids. MEASUREMENTS VAS pain scores at rest and with physical therapy, ropivacaine use, opioid use, and opioid-related side effects were recorded. MAINRESULTS:
Cummulative ropivacaine use was lower in patients whose catheter was placed by ultrasound than by nerve stimulator guidance (mean 50 vs 197 mL, P < 0.001). Pain scores at rest and during activity were similar between groups. Cumulative opioid consumption (mean 858 vs 809 mg oral morphine equivalents) and daily frequencies of nausea (5% to 33% vs 0 to 24%) and pruritus (0 to 21% vs 0 to 24%) were similar between groups. Length of hospital stay was similar between groups (3.5 vs 3.7 days).CONCLUSIONS:
Ultrasound guidance was associated with less local anesthetic consumption than with the nerve stimulator; however, there was little clinical benefit, as all other outcomes were similar between groups.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Analgesia, Patient-Controlled
/
Ultrasonography, Interventional
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Electric Stimulation
/
Nerve Block
Type of study:
Clinical_trials
/
Guideline
/
Observational_studies
/
Risk_factors_studies
Limits:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
J Clin Anesth
Journal subject:
ANESTESIOLOGIA
Year:
2012
Document type:
Article
Affiliation country:
United States