Abstract ID: A19
Abstract Title: Single shot femoral block with levobupivacaine for postoperative analgesia in arthroscopy reconstruction of ACL. Comparison of three different volumes
Authors: Espinosa W1, Rovira M2, Labzina J3, Salazar C4
Soccer Federation of Spain. Clinica FIATC Barcelona Barcelona Spain1, Soccer Federation of Spain. Clinica FIATC 2, Soccer Federation of Spain. Clinica FIATC 3, Hospital de Figueres 4
Poster Type: Either
ABSTRACT BODY
Introduction:
Single shot femoral block with of levobupivacaine has provided effective postoperative analgesia in arthroscopy reconstruction of anterior cruciate ligament of the knee. This study evaluates if 100 mg of levobupivacaine behave differently when it is injected in 20 ml, 30 ml or 40 ml volume.
Materials and Methods:
After institutional ethical approval 104 healthy soccer players were enrolled in the study. Surgery (bone-tendon-bone technique) was performed by the same team to all cases. Patients had intradural anesthesia with 10 to 12,5 mg of bupivacaine (L2-L3 or L3-L4 level; lateral decubitus; 27G pencil point spinal needle). Immediately afterwards a femoral block with 100 mg of levobupivacaine was carried out with a nerve stimulator and a Plexigon (Vygon®) insulated needle (patelar movement at 0.3-0.5 mA). Patients were randomly distributed in three groups receiving the 100 mg dose of levobupivacaine in three different volumes: 20 ml (0.5%), 30 ml (0.33%) or 40 ml (0.25%). Postoperative pain treatment consisted of paracetamol/codeine/diclofenac 600/300/50 mg PO TID; tramadol 100 mg IV was used as rescue analgesic. The collected data were: spinal block duration time, intra-operative events, time to beginning of pain, intensity of pain (VAS 0 to 10 at rest and movement at end of anesthesia and up to 24h plus a patient’s self evaluation pain scale as absent/mild, moderate, severe, unbearable), rescue analgesia if needed and secondary effects. Time values and VAS scores were compared with Student T test.
Results:
There were no differences between groups in demographic data nor in surgical time. There were no intra-operative pain or complications. Spinal block duration time ranged between 245 to 275 minutes and femoral block duration time (table 1) ranged between 510 to 690 minutes (difference non significant between groups). EVA score assessments are also in table 1(difference non significant between groups). Patients’ pain self assessments are in table 2. Tramadol rescue analgesia was needed in 1 case in G 20 ml, 2 cases in G 30 ml and 2 cases in G 40 ml. The only secondary effect detected was hyposthesia on the femoral nerve innervation area that lasted from 10 to 20 hours in many patients; 19 cases in G 20 ml, 8 cases in G 30 ml and 9 cases in G 40 ml (significant difference between G20 and the other groups); it subsided with no sequels.
Discussion:
Paracetamol/codeine/diclofenac PO TID plus femoral block with 100 mg levobupivacaine at different volumes (multimodal analgesia?) provide adequate 24h postoperative analgesia in this setting. Pain is absent for 10 to 11 hours; afterwards pain is absent or mild in 3 out of 4 patients. Lower mean VAS pain score was 2 at rest and 3 with movement. Patients pain self-assessment was absent or mild in 61%-77% cases, moderate in 14%-29% cases and severe in 5.5%-8% cases. Nevertheless tramadol rescue analgesia (100 mg IV single dose) was needed in 1-2 patients on each group. Hyposthesia of the femoral nerve was the only secundary effect observed; it occured for the first 12-24 hours and then subsided with sequels.
References:
Wang, Boctor et al. Reg Anesth Pain Med 2002; 27: 139-144
Espinosa, Salazar et al ASRA Spring Meeting Abtract A31
ATTACHED FILES
A19_ASRA 2006 Singl…opy rec ACL.doc
Reg Anesth Pain Med 2005; 30(3):A19