Research Articles | Challenge Journal of Perioperative Medicine

Comparison of the analgesic effects of different bupivacaine concentrations in continuous femoral block after total knee arthroplasty surgery

Murat Ünal, Serpil Şavlı Mete, Menşure Kaya, Abdurrahman Dünmez, Gülçin Özalp Şenel, Nihal Kadıoğulları


DOI: https://doi.org/10.20528/cjpm.2024.01.003
View Counter: Abstract | 70 times |, Full Article | 21 times |

Abstract


Aim: In regional anesthesia practice, anesthesists’ goal must be to use the lowest effective concentration of local anesthetics to provide sufficient pain relief while minimizing side effects and complications. This study was designed to compare the analgesic efficacy of two different concentrations of bupivacaine (0.125% and 0.1%) in continuous femoral block for postoperative analgesia.

Method: In this study, fifty patients were enrolled, all of whom underwent femoral nerve block catheterization. The block procedure involved the administration of 30ml of bupivacaine solution at a concentration of 0.25%. Following a thirty-minute interval post-block application, patients underwent knee surgery under general anesthesia. During the closure of subcutaneous tissues, an additional 10ml of bupivacaine solution was injected through the catheter. Two groups were formed based on the concentration of the solution administered: Group(0.125%) received bupivacaine at a concentration of 0.125%, while Group(0.1%) received it at a concentration of 0.1%. Subsequently, upon arrival at the postoperative care unit, infusion through the catheter commenced at a rate of 10ml/h-1, maintaining the same concentrations for both groups. In addition to the nerve block, all patients were provided with intravenous Patient Controlled Analgesia (PCA) devices containing morphine for pain management. Throughout the postoperative period, sensory and motor block levels, Numerical Rating Scale (NRS) values for static and dynamic pain assessment, total morphine consumption, morphine demand, as well as any observed side effects and complications, were meticulously recorded for analysis.

Results: Postoperatively the NRSstatic values at 24th and 48th hours and NRSdynamic values at the 24th hour were higher in Group(0.1%) and it was statistically significant(p<0,007). And at 48th hour, morphine consumption was significantly higher in Group(0.1%) (p<0,05).

Conclusions: In our study, all patients across both experimental groups initially experienced satisfactory analgesia. However, within the 24-hour postoperative period, Group(0.1%) exhibited a decline in the quality of analgesia, necessitating increased utilization of rescue analgesics. This escalation in rescue analgesic use was associated with a higher incidence of adverse effects and reduced patient comfort levels within this group. Consequently, our findings indicate that the 0.125% concentration of bupivacaine yielded superior efficacy compared to the 0.1% concentration in the context of continuous femoral block administration.


Keywords


femoral nerve; bupivacaine; local anesthetics; nerve blocks; regional anesthesia

Full Text:

PDF

References


Bailey L, Griffin J, Elliott M, Wu J, Papavasiliou T, Harner C, Lowe W. Adductor canal nerve versus femoral nerve blockade for pain control and quadriceps function following anterior cruciate ligament reconstruction with patellar tendon autograft: A prospective randomized trial. Arthroscopy. 2019; 35(3):921-929.

Morsy KM, Gad-Elrab FA, Elzohry AAM, Abdelhafeez AM. Effect of adding fentanyl to bupivacaine in femoral nerve block for post-operative pain in patient subjected to total knee replacement guided by ultrasound. Anaesth Pain Med. 2019; 1(1):06-11.

Lewis SR, Price A, Walker KJ, McGrattan K, Smith AF. Ultrasound guidance for upper and lower limb blocks. Cochrane Database Syst Rev. 2015; (9):CD006459.

Strid JMC, Sauter AR, Ullensvang K, Andersen MN, Daugaard M, Bendtsen MAF, Søballe K, Pedersen EM, Børglum J, Bendtsen F. Ultrasound-guided lumbar plexus block in volunteers; a randomized controlled trial. BJA: Br J Anaesth. 2017; 118(3):430–438.

Ilfeld BM. Continuous peripheral nerve blocks: An update of the published evidence and comparison with novel, alternative analgesic modalities. Anesth Analg. 2017; 124(1):308-335.

Vishwanatha S, Kalappa S. Continuous femoral nerve blockade versus epidural analgesia for postoperative pain relief in knee surgeries: A randomized controlled study. Anesth Essays Res. 2017; 11(3):599-605.

Bugada D, Allegri M, Gemma M, Ambrosoli AL, Gazzerro G, Chiumiento F, Dongu D, Nobili F, Fanelli A, Ferrua P, Berruto M, Cappelleri G. Effects of anaesthesia and analgesia on long-term outcome after total knee replacement: A prospective, observational, multicentre study. Eur J Anaesthesiol. 2017; 34(10):665-672.

Tetsunaga T, Sato T, Shiota N, Tetsunaga T, Yoshida M, Okazaki Y, Yamada K. Comparison of continuous epidural analgesia, patient-controlled analgesia with morphine, and continuous three-in-one femoral nerve block on postoperative outcomes after total hip arthroplasty. Clin Orthop Surg. 2015; 7(2):164-170.

Sahin L, Korkmaz HF, Sahin M, Atalan G, Ultrasound-guided single-injection femoral nerve block provides effective analgesia after total knee arthroplasty up to 48 hours. Agri. 2014; 26: 113-118.

MacLean D, Abdallah FW. Ultrasound-guided regional anesthesia. Anesthesia & Analgesia. 2017; 125(4):1406.

Tulgar S, Selvi O, Senturk O, Serifsoy TE, Sanel S, Meydaneri S. Evaluation of analgesic regimens in total knee arthroplasty, retrospective study. North Clin Istanb. 2017; 4(2):124-130.

Zhang T, Zhang T, Niu X. et al. Femoral nerve block using lower concentration ropivacaine preserves quadriceps strength while providing similar analgesic effects after knee arthroscopy. Knee Surg Sports Traumatol Arthrosc. 2023; 31:4988–4995.

Veneziano G, Tripi J, Tumin D, Hakim M, Martin D, Beltran R, Klingele K, Bhalla T, Tobias JD. Femoral nerve blockade using various concentrations of local anesthetic for knee arthroscopy in the pediatric population. J Pain Res. 2016; 9:1073-1079.

Beebe MJ, Allen R, Anderson MB, Swenson JD, Peters CL. Continuous femoral nerve block using 0.125% bupivacaine does not prevent early ambulation after total knee arthroplasty. Clin Orthop Relat Res. 2014; 472(5):1394-9.

Iamaroon A, Tangwiwat S, Sirivanasandha B, Halilamien P, Lertpenmetha Y, Sirimaneewattana S, Surachetpong S, Puangchan S. Femoral nerve block using 0.25% or 0.5% bupivacaine for analgesia after arthroscopic anterior cruciate ligament reconstruction. J Med Assoc Thai. 2014; 97(7):717-23.

Hussain N, McCartney CJL, Neal JM, et al. Local anaesthetic induced myotoxicity in regional anaesthesia: A systematic review and empirical analysis. Br J Anaesth. 2018; 121:822–841.

Kim MK, Ko SH, Hwang YJ, Kwon DG, Jeon YS, Ryu DJ. Effectiveness of continuous femoral nerve block for pain relief after total knee arthroplasty: comparison with epidural patient-controlled analgesia and periarticular injection. Journal of International Medical Research. 2022; 50(4).

Behera SK, Gunupuru B, Sahu L, Das S. Peripheral nerve stimulator versus ultrasound-guided femoral nerve block for knee arthroscopy procedures: A randomized controlled trial. Cureus. 2022; 14(11):e32043.

Freccero DM, Van Steyn P, Joslin PMN, Robbins CE, Li X, Efremov K, Shukla P, Talmo CT, Bono JV. Continuous femoral nerve block reduces the need for manipulation following total knee arthroplasty. JBJS Open Access. 2022; 7(3):e21.00155.

Lyngeraa TS. Bacterial growth from adductor canal block nerve catheters removed after 48 hours in situ. BJA: Br J Anaesth. 2015; 115.

O'Flaherty D, McCartney CJL, Ng SC. Nerve injury after peripheral nerve blockade-current understanding and guidelines. BJA Educ. 2018; 18(12):384-390.


Refbacks

  • There are currently no refbacks.