Kerscher, C. and Drescher, J. and Graf, B. M. and Bonnlaender, G. (2011) Efficiency of various types of catheter for continuous psoas compartment block for intra- and postoperative analgesia in total knee replacement. ANASTHESIOLOGIE & INTENSIVMEDIZIN, 52. 748-+. ISSN 0170-5334,
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Background: Continuous psoas compartment and transgluteal sciatic nerve blocks are widely used techniques for intra- and postoperative analgesia in patients undergoing a total knee replacement. Owing to the high anatomical variability in the course of the three nerves (femoral, lateral femoral cutaneous and obturator nerve) of the lumbar plexus in and round the psoas muscle, multiple interventions by the pain service are often required. In the present study, the respective efficiency of the three catheter types Contiplex (R) single-hole (B.Braun), Perifix (R) One multi-hole (B.Braun) and StimuLong (R) stimulating catheter (Pajunk) were compared in terms of effective postoperative analgesia with the fewest manipulation needs. Methods: This prospective, non-randomized study included 90 patients, who received a total knee replacement in the psoas compartment (described by Chayen [17]) and a transgluteal sciatic nerve block (Labat [18]) at the Asklepios Clinic in Bad Abbach. To block the lumbar plexus, 30 patients in each group received one of the three above-mentioned catheters, through which a local anesthetic was applied postoperatively at a continuous rate (ropivacaine 0.2%. 10 ml/h) together with the option of patient-controlled bolus administration (16 mg ropivacaine 0.2%, 8 ml). In accordance with a standardized pain protocol, the pain service could also apply a local anaesthetic (200 mg prilocaine 1%, 20 ml) via a catheter, correct the position of the Contiplex (R) single-hole catheter, or administer intravenous analgesics. In a standardized study protocol, the pain intensity as determined by a visual analog scale (VAS 0-10), and interventions by the pain service in the first 48 postoperative hours were listed, and then analyzed with SPSS. Results: All patients underwent surgery only under regional anaesthesia and propofol sedation. In all cases, primary regional anaesthesia was successful. The median pain intensity in the first 48 hours indicated by patients of all three groups was <2 (VAS 0-10). Patients with a Contiplex (R) single-hole catheter applied significantly more boll (mean 6.1 +/- SD 3.4) via PCA than did those in the multi-hole (mean 3.1 +/- SD 1.9) or the stimulation catheter group (mean 3.9 +/- SD 2.4) (p<0.000). 23.4% (n=7) of the patients with a Perifix (R) One multi-hole catheter again received local anaesthetics from the pain service; no catheter had to be position-corrected. In comparison, in 73.4% (n=22) of the Contiplex (R) single-hole and 56.7% (n=17) of the StimuLong (R) stimulating catheters additional local anaesthetic was applied (p<0.000). 12 (36.7/0) of the Contiplex (R) single-hole catheters were drawn back to stimulation level, but none of the StimuLong (R) stimulating catheters. Significantly fewer patients with the multi-hole catheter received additional piritramide as compared with the other two groups (p <0.028). The mean use of piritramide (p <0.008) and metamizol (p<0.002) was also significantly smaller for the Perifix (R) One multi-hole catheters. During the postoperative period inadequate analgesia prompted replacement of three of the Contiplex (R) single-hole catheters (10.0%) and five of the StimuLong (R) stimulating catheters (16.7%) by femoral nerve catheters, but none of the Perifix (R) multi-hole catheters were replaced. This trend was, however, not statistically significant (p<0.075). Conclusion: While pain levels were comparable in the three groups, the Perifix (R) One multi-hole catheter was clearly superior to the other two catheters in terms of a significantly reduced need for intervention, and this enabled a reliable, continuous blockade of the lumbar plexus.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | FEMORAL NERVE BLOCK; LUMBAR PLEXUS BLOCK; EPIDURAL ANALGESIA; STIMULATING CATHETERS; SCIATIC BLOCK; BLINDED TRIAL; ARTHROPLASTY; PAIN; 3-IN-ONE; REHABILITATION; Total Knee Replacement; Psoas Compartment Block; Transgluteal Sciatic Nerve Block; Lumbar Plexus; Postoperative Analgesia |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Anästhesiologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 28 May 2020 07:42 |
| Last Modified: | 28 May 2020 07:42 |
| URI: | https://pred.uni-regensburg.de/id/eprint/20026 |
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