The efficacy comparison of on-demand boluses with and without basal infusion of 0.1 % bupivacaine via perineural femoral catheter after arthroscopic ACL reconstruction

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 21; no. 3; pp. 641 - 645
• Main Authors: Svediene, Saule, Andrijauskas, Audrius, Ivaskevicius, Juozas, Saikus, Andrius
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.03.2013; Springer Nature B.V
• Subjects: Adolescent; Adult; Analgesia, Patient-Controlled; Analgesics; Anesthetics, Local - administration & dosage; Anterior Cruciate Ligament Reconstruction; Arthroscopy; Bupivacaine - administration & dosage; Catheterization; Catheters; Data collection; Humans; Infusion pumps; Knee; Ligaments; Medicine; Medicine & Public Health; Middle Aged; Nerve Block - methods; Orthopedics; Pain; Pain, Postoperative - drug therapy; Patient satisfaction; Surgery; Young Adult; Germany; Continuous femoral nerve block; Patient controlled analgesia
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-012-1971-0

Purpose Optimal postoperative analgesia after anterior cruciate ligament repair remains challenging. The objective of this prospective experimental clinical study was to compare the postoperative analgesic efficacy of two infusion regimens of 0.1 % bupivacaine administered via perineural femoral catheter. Methods Forty adult ASA I and II patients undergoing anterior cruciate ligament reconstruction were enrolled. Surgery was performed under spinal anesthesia combined with femoral nerve block. A perineural femoral catheter was connected to the patient controlled analgesia infusion pump filled with 0.1 % bupivacaine for postoperative pain control. Subjects were assigned to one of two groups according to the bupivacaine infusion regimen: (1) 5 mL/h basal infusion with on-demand 5 mL boluses and 30-min refractive periods, and (2) only on-demand 5 mL boluses and 15-min refractive periods. Quality of postoperative analgesia, adjunctive analgesic consumption, and overall patient satisfaction were recorded for 48 h. Results Pain control was better in Group I on the day of surgery ( P  = 0.001) and on the first postoperative day at rest and during mobilization ( P  = 0.02 and P  = 0.009). On the second postoperative day, only pain control during mobilization was better in Group I ( P  = 0.047). Adjunctive analgesic consumption and patient satisfaction were similar. Conclusion Perineural femoral infusion of on-demand 5 mL boluses of 0.1 % bupivacaine combined with 5 mL/h basal infusion was more efficient than on-demand regimen alone for postoperative pain management after reconstruction of anterior cruciate ligament of the knee. Level of evidence II.