Catheter Orifice Configuration (Six-hole Versus End-hole) on Post-operative Analgesia After Total Knee Arthroplasty.

University Hospital, Geneva72 enrolled

Overview

Multiorifice catheters have been shown to provide superior analgesia and significantly reduce local anesthetic consumption compared with end-hole catheters in epidural studies. This prospective, blinded, randomized study tested the hypothesis that, in continuous femoral nerve block (CFNB) under ultrasound guidance, multiorifice catheter would reduce local anesthetic consumption at 24h compared with end-hole catheter.

Eighty adult patients (aged ≥18 years) scheduled to undergo primary total knee arthroplasty under a combination of continuous femoral nerve block (CFNB), sciatic nerve block and general anesthesia were randomized to CFNB using either a 3-pair micro-hole (Contiplex, BRAUN®, 20G - 400 mm) or an end-hole (Silverstim VYGON®, 20G - 500 mm) catheter. Once the femoral catheter was sited, a bolus of 20 mL lidocaine 1% was injected. An electronic pump then delivered an automated 5 mL bolus of ropivacaine 0.2% hourly, with 10 mL self-administered patient controlled analgesia boluses.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

TRIPLE

Enrollment

Conditions

Pain

Interventions

lidocaine and ropivacaine injection through cathetersCOMBINATION_PRODUCT

injection of local anesthetic through an endhole or a sixhole femoral nerve catheter in the context of total knee replacement. Analgesic properties at 24 and 48h of both groups registered.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * every patient accepting a conitnuous femoral nerve catheter Exclusion Criteria: * pregnancy, * any contraindication to peripheral nerve blockade, * pre-existing peripheral nerve neuropathy, * allergy to LA (study medications), * ASA score ≥4, * neurologic or neuromuscular disease, * psychiatric disease, * renal failure, * hepatic failure, * chronic opioid therapy, * NSAID contraindication, * inability to use a patient controlled analgesia (PCA) device, g * enu valgum, * infection at the injection site or * withdrawal of consent.

Locations (1)

University hospitals of Geneva

Geneva, Switzerland

Outcomes

Primary Outcomes

total LA consumption at 24h

total ropivacaine consumption at 24h in mL

Time frame: 24h after connecting PCA to the femoral nerve catheter

Secondary Outcomes

total LA consumption at 48h

total ropivacaine consumption at 48h in mL

Time frame: 48h after connecting PCA to the femoral nerve catheter

number of boluses of ropivacaine at 24h

total ropivacaine boluses received at 24h in numbers

Time frame: 24h after connecting PCA to the femoral nerve catheter

number of boluses of ropivacaine at 48 h

total ropivacaine boluses received at 48h in numbers

Time frame: 48h after connecting PCA to the femoral nerve catheter

quadriceps strength before surgery and 24h and 48h after surgery

quadriceps strength measured with with an electronic dynamometer in N.m and percentage of preblock value of MVIC

Time frame: quadriceps strenght before performing femoral nerve block and 24 and 48h after performing the block

morphine requirements at 24h and 48h

rescue morphine 24h and 48h in mg

Time frame: morphine consumption at 24h and 48h after completion of surgery

Data from ClinicalTrials.gov

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