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CONTINUOUS FEMORAL NERVE BLOCK: COMPARISON BETWEEN TWO RATES OF DRUG INFUSION USING 0.125% LEVOBUPIVACAINE FOR POSTOPERATIVE PAIN CONTROL IN SURGERY TOTAL KNEE REPLACEMENT
ESRA Academy. De Andres J. Sep 8, 2016; 138488
Topic: Patient Controlled Analgesia
Prof. Jose De Andres
Prof. Jose De Andres

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Abstract
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Background and Aims:

Total knee replacement(TKR) is associated to severe postoperative pain.For its control,continuous femoral nerve block(CFNB)analgesia has proven as a successful technique.Our goal is to evaluate the efficiency and safety of two infusion rates of 0.125% levobupivacaine through a CFNB after TKR.

Methods:

Comparative and retrospective study of 467 patients scheduled to TKR with postoperative analgesia using CFNB between 2014-2016.Patients are divided in two groups,depending on the infusion rate with 0.125% levobupivacaine:7 ml/h or 12 ml/h.For both groups, complementary analgesia was conducted with paracetamol and dexketoprofen.Demographic characteristics,VAS(mm) scores at rest and in motion after 24h,dispensed boluses and complications were recorded.

Results:

442 patients were included,251 in the 7ml/h infusion rate group and 191 in the 12ml/h one.No demographic differences were found among both groups.The group of 12ml/h registered slightly lower VAS medium levels than the 7 ml/h group after 24h,being statistically not significant(p>0.05).Patients that received an infusion rate of 7 ml/h needed a higher amount of boluses than those of the 12 ml/h group(5 or more boluses:52% in 7 ml/h group vs.36% in the 12ml/h group).
The best choice of local anesthesic,including concentration and optimal volume,is controversial.Infusion rates under  7ml/h for CFNB have been proven to be inefficient,but the use of higher rates has not yet been sufficiently studied.

Conclusions:

Using of high infusion rates(12ml/h) of 0.125% levobup. through a CFNB delivers a better analgesia in comparison to moderated rates(7ml/h) without increasing complications.Further,a high infusion rate seems to decrease the necessity of rescue analgesia and the occurrence of nausea and vomiting due to lower opioids consumption 

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