Minimum effective concentration of bupivacaine in ultrasound-guided femoral nerve block after arthroscopic knee meniscectomy: a randomized, double-blind, controlled trial

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dc.contributor.authorRey Moura, Ed Carlos [UNIFESP]
dc.contributor.authorde Oliveira Honda, Claudio Alex [UNIFESP]
dc.contributor.authorTeixeira Bringel, Roberto Cesar [UNIFESP]
dc.contributor.authorLeal, Plinio da Cunha [UNIFESP]
dc.contributor.authorLopes Filho, Gasper de Jesus [UNIFESP]
dc.contributor.authorSakata, Rioko Kinmiko [UNIFESP]
dc.date.accessioned2019-01-21T10:30:12Z
dc.date.available2019-01-21T10:30:12Z
dc.date.issued2016
dc.description.abstractBackground: Adequate analgesia is important for early hospital discharge after meniscectomy. A femoral nerve block may reduce the need for systemic analgesics, with fewer side effectsen
dc.description.abstracthowever, motor block can occur. Ultrasound-guided femoral nerve block may reduce the required local anesthetic concentration, preventing motor block. Objective: The primary objective of this study was to determine the lowest effective analgesic concentration of bupivacaine in 50% (EC50) and in 90% (EC90) of patients for a successful ultrasoundguided femoral nerve block in arthroscopic knee meniscectomy. Study Design: This was a prospective, randomized, double-blind, controlled trial. Settings: This study was conducted at Hospital Sao Domingos. Methods: A total of 52 patients undergoing arthroscopic knee meniscectomy were submitted to ultrasound-guided femoral nerve block using 22 mL bupivacaine. The bupivacaine concentration given to a study patient was determined by the response of the previous patient (a biased-coin design up-down sequential method). If the previous patient had a negative response, the bupivacaine concentration was increased by 0.05% for the next case. If the previous patient had a positive response, the next patient was randomized to receive the same bupivacaine concentration (with a probability of 0.89) or to have a decrease by 0.05% (with a probability of 0.11). A successful block was defined by a numerical pain intensity scale score < 4 (0 = no painen
dc.description.abstract10 = worst imaginable pain) in 3 different evaluations. If the pain intensity score was >= 4 (moderate or severe pain) at any time, the block was considered failed. General anesthesia was induced with 30 mu g/kg alfentanil and 2 mg/kg propofol, followed by propofol maintanance, plus remifentanil if needed. Postoperative analgesia supplementation was performed with dipyroneen
dc.description.abstractketoprofen and tramadol were given if needed. Data Measurements: The following parameters were evaluated: numerical pain intensity score, duration of analgesia, supplementary analgesic dose in 24 hours, and need for intraoperative remifentanil. Results: The EC50 was 0.160 (95% CI: 0.150 - 0.189), and EC90 was 0.271 (95% CI: 0.196 - 0.300). There was no difference in numerical pain intensity score for the different concentrations of bupivacaine. A successful block was achieved in 45 patients, with no difference according to bupivacaine concentration. Time to first analgesic supplementation dose was longer for bupivacaine concentrations >= 0.3% (543.8 +/- 283.8 min.), compared to 0.25% (391.3 +/- 177.8 min.) and < 0.25% (302.3 +/- 210.1 min.). There were no differences in supplementary analgesic dose in 24 hours nor in the use of intraoperative remifentanil according to bupivacaine concentration. Limitations: The analgesic effect was measured only during the first 2 hours. Conclusions: Bupivacaine EC50 for ultrasound-guided femoral nerve block was 0.160 (95% CI: 0.150 - 0.189), and EC90 was 0.271 (95% CI: 0.196 - 0.300).en
dc.description.affiliationDepartment of Anesthesia,Universidade Federal de São Paulo, Rue Tres de Maio – 61/51 Sao Paulo, Brazil
dc.description.affiliationUnifespDepartment of Anesthesia,Universidade Federal de São Paulo, Rue Tres de Maio – 61/51 Sao Paulo, Brazil
dc.description.sourceWeb of Science
dc.format.extentE79-E86
dc.identifierhttp://www.painphysicianjournal.com/linkout?issn=1533-3159&vol=19&page=E79
dc.identifier.citationPain Physician. Paducah, v. 19, n. 1, p. E79-E86, 2016.
dc.identifier.issn1533-3159
dc.identifier.urihttp://repositorio.unifesp.br/handle/11600/49632
dc.identifier.wosWOS:000368990800005
dc.language.isoeng
dc.publisherAm soc interventional pain physicians
dc.relation.ispartofPain Physician
dc.rightsinfo:eu-repo/semantics/openAccess
dc.subjectPostoperative Analgesiaen
dc.subjectFemoral Blocken
dc.subjectUltrasound-Guideden
dc.subjectBupivacaine Minimum Concentrationen
dc.subjectArthroscopic MeniscectomyPostoperative Analgesiaen
dc.subjectIntrathecal Morphineen
dc.subjectSpinal-Anesthesiaen
dc.subjectDown Methoden
dc.subjectArthroplastyen
dc.subjectVolumeen
dc.subjectRopivacaineen
dc.subjectVolunteersen
dc.subjectPainen
dc.titleMinimum effective concentration of bupivacaine in ultrasound-guided femoral nerve block after arthroscopic knee meniscectomy: a randomized, double-blind, controlled trialen
dc.typeinfo:eu-repo/semantics/article
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