Comparison of the analgesic effect of an adductor canal block using a new suture-method catheter vs. standard perineural catheter vs. single-injection: a randomised, blinded, controlled study.

We performed a randomised, blinded, controlled study with adult patients scheduled for primary total knee arthroplasty under spinal anaesthesia. The aim was to investigate the analgesic effects of adductor canal block using catheter-based repeated boluses, either through a new suture-method catheter or a standard perineural catheter, compared with a single-injection technique. All patients received an adductor canal block after surgery with an initial bolus of 20 ml ropivacaine 0.75%, followed by 20 ml of ropivacaine 0.2% every 8 h in the standard and suture-method catheter groups, and sham boluses for the single-injection group. The primary outcome measure was total opioid consumption (intravenous morphine equivalents) from the end of surgery until 12:00 on postoperative day 2. Secondary outcomes were pain, muscle strength and ambulation. We randomly assigned (1:1:1) and analysed 153 patients. Total opioid consumption was median (IQR [range]) 24 (11-37 [0-148]) mg in the suture-method group, 38 (17-51 [0-123]) mg in the standard catheter group and 37 (14-57 [0-158]) mg in the single-injection group (p = 0.049). Differences were not statistically significant after Bonferroni correction (α = 0.05/3). There were no differences between groups on postoperative day 1. On postoperative day 2, there were no differences between catheter groups, but muscle strength and ambulation were improved compared with the single-injection group. We conclude that providing repeated boluses via a catheter did not decrease opioid consumption or pain compared with a single injection, but improved muscle strength and ambulation on postoperative day 2. The two types of catheters were similar.

Rapid microassays for clindamycin and gentamicin when present together and the effect of pH and of each on the antibacterial activity of the other.

Gentamicin was measured in the presence of clindamycin by using as the assay organism a strain of Staphylococcus aureus that was resistant to clindamycin; clindamycin was measured in the presence of gentamicin by using Clostridium perfringens as the assay organism. Both assays were in agar diffusion systems, were rapid (2 to 4 h), and had errors of less than 10%. Neither antibiotic antagonized or synergized with the other against a variety of organisms. The pK of clindamycin was 7.3, and the pK of gentamicin was 8.2. Gentamicin was 100 or more times as active in alkaline medium against both gram-positive and gram-negative organisms, but clindamycin showed a striking pH effect on activity only with gram-positive organisms.