Stimulating or conventional perineural catheters after hallux valgus repair: a double-blind, pharmaco-economic evaluation

• Published in: Acta anaesthesiologica Scandinavica Vol. 50; no. 10; pp. 1284 - 1289
• Main Authors: Casati, A., Fanelli, G., Danelli, G., Baciarello, M., Ghisi, D., Nobili, F., Chelly, J. E.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.11.2006; Blackwell
• Subjects: Adult; Aged; Aged, 80 and over; Amides - administration & dosage; Amides - therapeutic use; Analgesia, Patient-Controlled; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Local - administration & dosage; Anesthetics, Local - pharmacology; Anesthetics, Local - therapeutic use; Biological and medical sciences; Body Size; Catheterization - methods; cost analysis; Double-Blind Method; Female; Hallux Valgus - surgery; hallux valgus repair; Humans; Male; Medical sciences; Middle Aged; Nerve Block; nerve stimulator; Placebos; Postoperative Care; ropivacaine; Sciatic Nerve - drug effects; sciatic nerve block; stimulating catheters; Deformation; Diseases of the osteoarticular system; Catheter; Hallux valgus; sciatic nerve block; Ropivacaine; stimulating catheters; Local anesthetic; nerve stimulator; Anesthesia; Organic amide; hallux valgus repair; Cost analysis
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1111/j.1399-6576.2006.01101.x

Background:  We prospectively evaluated direct analgesia‐related costs of continuous sciatic nerve block using either a stimulating or conventional catheter after hallux valgus repair. Methods:  The perineural catheter was inserted through a stimulating introducer either blindly (group Conventional, n= 38) or while stimulating via the catheter (group Stimulating, n= 38). Nerve block was induced with 25 ml of mepivacaine 15 mg/ml, and was followed 3 h later by a patient‐controlled infusion of ropivacaine 2 mg/ml (basal infusion: 3 ml/h; incremental dose: 5 ml; lock‐out time: 30 min). Rescue tramadol [100 mg intravenous (i.v.)] was given if required. Local anesthetic consumption, need for rescue tramadol and post‐operative nausea and vomiting (PONV) treatment, and patient’s satisfaction were recorded during first 24‐h infusion. Cost calculations were based on the acquisition cost of drugs and devices. Results:  Both techniques were similarly effective, but local anesthetic consumption and need for rescue analgesics were lower in the Stimulating group [respectively, 120 vs. 153 ml (P= 0.004) and 21% vs. 60% (P= 0.001)]. The analgesia‐related costs for 24 h were similar when 100‐ml bags of ropivacaine 2 mg/ml were used (66 € vs. 67 €; P= 0.26). When 200‐ml bags of ropivacaine were used, the analgesia‐related costs were higher in the Stimulating group than the Conventional group (75 € vs. 55 €; P= 0.0005). Conclusions:  Direct costs of continuous sciatic nerve block ranged from 55 to 75 €. Stimulating catheters reduced local anesthetic consumption and need for rescue analgesics. This was only cost effective when 100‐ml bags of 2 mg/ml ropivacaine were used, while the cheapest combination was the use of conventional catheters and 200‐ml bags of ropivacaine.