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Determination of the EC50 of levobupivacaine for femoral and sciatic perineural infusion after total knee arthroplasty

2009; Elsevier BV; Volume: 102; Issue: 4 Linguagem: Inglês

10.1093/bja/aep010

1471-6771

Graeme McLeod, J. Kim Dale, Dror Robinson, M. R. Checketts, Malachy O. Columb, Jonathan Luck, C.A. Wigderowitz, Samuel Rowley,

Dental Anxiety and Anesthesia Techniques

BackgroundInfusion of local anaesthetic through femoral and sciatic catheters is an accepted method of providing pain relief after knee arthroplasty. However, the minimum effective concentration of perineural local anaesthetics is not known.MethodsTwenty-four patients received femoral and sciatic perineural infusions of levobupivacaine in order to prevent pain relief after total knee arthroplasty. The primary endpoint of the study was patient request for analgesic rescue for anterior or posterior knee pain within the first 36 h of perineural infusion. Treatment was determined by the method of sequential allocation, with a dosing interval of 0.002% w/v.ResultsThirteen patients did not require rescue analgesia for anterior knee pain and 16 patients did not require rescue analgesia for posterior knee pain. Median duration of failed blocks until rescue analgesia was 25 h (24–27 h) for the femoral block and 27 h (24–29 h) for the sciatic block. The minimum concentration at which patients did not require rescue analgesia was 0.024% for the femoral nerve and 0.014% for the sciatic nerve. Comparison of EC50 showed that local anaesthetic requirements were significantly (P=0.03) higher by a factor of 1.25 (95% CI 1.03–1.55) for the femoral compared with the sciatic nerve.ConclusionsThe EC50 for femoral perineural infusion is greater than the EC50 for sciatic perineural infusion. Infusion of local anaesthetic through femoral and sciatic catheters is an accepted method of providing pain relief after knee arthroplasty. However, the minimum effective concentration of perineural local anaesthetics is not known. Twenty-four patients received femoral and sciatic perineural infusions of levobupivacaine in order to prevent pain relief after total knee arthroplasty. The primary endpoint of the study was patient request for analgesic rescue for anterior or posterior knee pain within the first 36 h of perineural infusion. Treatment was determined by the method of sequential allocation, with a dosing interval of 0.002% w/v. Thirteen patients did not require rescue analgesia for anterior knee pain and 16 patients did not require rescue analgesia for posterior knee pain. Median duration of failed blocks until rescue analgesia was 25 h (24–27 h) for the femoral block and 27 h (24–29 h) for the sciatic block. The minimum concentration at which patients did not require rescue analgesia was 0.024% for the femoral nerve and 0.014% for the sciatic nerve. Comparison of EC50 showed that local anaesthetic requirements were significantly (P=0.03) higher by a factor of 1.25 (95% CI 1.03–1.55) for the femoral compared with the sciatic nerve. The EC50 for femoral perineural infusion is greater than the EC50 for sciatic perineural infusion.