Novello-Siegenthaler Alessandra, Hamdani Mehdi, Iselin-Chaves Irène, Fournier Roxane
Department of Anesthesiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1211, Geneva 14, Switzerland.
Clinique Générale-Beaulieu, Geneva, Switzerland.
BMC Anesthesiol. 2018 Dec 19;18(1):191. doi: 10.1186/s12871-018-0648-8.
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 24 h compared with end-hole catheter.
Eighty adult patients (aged ≥18 years) scheduled to undergo primary total knee arthroplasty under a combination of 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.
There was no inter-group difference in either median number of ropivacaine boluses on demand during the first 24 h (4(2-7) vs. 4(2-8) in six-hole and end-hole groups, respectively; P = 0.832) or median ropivacaine consumption at 48 h (365(295-418) vs. 387(323-466); P = 0.452). No significant differences were recorded between the groups at 24 h regarding median average verbal rate pain scale (2(0-3) vs. 2(0-4); P = 0.486) or morphine consumption (0(0-20) vs. 0(0-20); P = 0.749). Quadriceps muscle strength declined to 7% (0-20) and 10% (0-28) in the six-hole and end-hole groups, respectively, at 24 h after surgery (P = 0.733).
In this superiority trial, catheter orifice configuration did not influence the effectiveness of CFNB in this setting: quality of analgesia was similar, with no reduction in either local anesthetic or morphine consumption, and equivalent postoperative quadriceps weakness.
Retrospectively registered at ( NCT03376178 ). Date: 21 November 2017.
在硬膜外研究中，与单孔导管相比，多孔导管已被证明能提供更好的镇痛效果，并显著减少局部麻醉药的用量。这项前瞻性、双盲、随机研究检验了以下假设：在超声引导下的连续股神经阻滞（CFNB）中，与单孔导管相比，多孔导管在24小时时能减少局部麻醉药的用量。
80例计划在CFNB、坐骨神经阻滞和全身麻醉联合下进行初次全膝关节置换术的成年患者（年龄≥18岁）被随机分为使用3对微孔导管（Contiplex，贝朗公司，20G - 400mm）或单孔导管（Silverstim VYGON公司，20G - 500mm）进行CFNB。股神经导管放置好后，注射20mL 1%利多卡因推注量。然后，电子泵每小时自动输送5mL 0.2%罗哌卡因推注量，同时患者自控镇痛推注量为10mL。
在最初24小时内，按需使用罗哌卡因推注量的中位数在两组间无差异（六孔组和单孔组分别为4（2 - 7）和4（2 - 8）；P = 0.832），48小时时罗哌卡因用量中位数也无差异（365（295 - 418）对387（323 - 466）；P = 0.452）。在24小时时，两组在平均言语疼痛评分中位数（2（0 - 3）对2（0 - 4）；P = 0.486）或吗啡用量（0（0 - 20）对0（0 - 20）；P = 0.749）方面无显著差异。术后24小时，六孔组和单孔组股四头肌力量分别下降至7%（0 - 20）和10%（0 - 28）（P = 0.733）。
在这项优效性试验中，导管孔配置在这种情况下并未影响CFNB的有效性：镇痛质量相似，局部麻醉药或吗啡用量均未减少，术后股四头肌无力程度相当。
回顾性注册于（NCT03376178）。日期：2017年11月21日。
