Minimum effective concentration of bupivacaine in ultrasound-guided femoral nerve block after arthroscopic knee meniscectomy: a randomized, double-blind, controlled trial

Detalhes bibliográficos
Autor(a) principal: Rey Moura, Ed Carlos [UNIFESP]
Data de Publicação: 2016
Outros Autores: de Oliveira Honda, Claudio Alex [UNIFESP], Teixeira Bringel, Roberto Cesar [UNIFESP], Leal, Plinio da Cunha [UNIFESP], Lopes Filho, Gasper de Jesus [UNIFESP], Sakata, Rioko Kinmiko [UNIFESP]
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da UNIFESP
Texto Completo: http://www.painphysicianjournal.com/linkout?issn=1533-3159&vol=19&page=E79
http://repositorio.unifesp.br/handle/11600/49632
Resumo: Background: Adequate analgesia is important for early hospital discharge after meniscectomy. A femoral nerve block may reduce the need for systemic analgesics, with fewer side effects
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spelling Minimum effective concentration of bupivacaine in ultrasound-guided femoral nerve block after arthroscopic knee meniscectomy: a randomized, double-blind, controlled trialPostoperative AnalgesiaFemoral BlockUltrasound-GuidedBupivacaine Minimum ConcentrationArthroscopic MeniscectomyPostoperative AnalgesiaIntrathecal MorphineSpinal-AnesthesiaDown MethodArthroplastyVolumeRopivacaineVolunteersPainBackground: Adequate analgesia is important for early hospital discharge after meniscectomy. A femoral nerve block may reduce the need for systemic analgesics, with fewer side effectshowever, motor block can occur. Ultrasound-guided femoral nerve block may reduce the required local anesthetic concentration, preventing motor block. Objective: The primary objective of this study was to determine the lowest effective analgesic concentration of bupivacaine in 50% (EC50) and in 90% (EC90) of patients for a successful ultrasoundguided femoral nerve block in arthroscopic knee meniscectomy. Study Design: This was a prospective, randomized, double-blind, controlled trial. Settings: This study was conducted at Hospital Sao Domingos. Methods: A total of 52 patients undergoing arthroscopic knee meniscectomy were submitted to ultrasound-guided femoral nerve block using 22 mL bupivacaine. The bupivacaine concentration given to a study patient was determined by the response of the previous patient (a biased-coin design up-down sequential method). If the previous patient had a negative response, the bupivacaine concentration was increased by 0.05% for the next case. If the previous patient had a positive response, the next patient was randomized to receive the same bupivacaine concentration (with a probability of 0.89) or to have a decrease by 0.05% (with a probability of 0.11). A successful block was defined by a numerical pain intensity scale score < 4 (0 = no pain10 = worst imaginable pain) in 3 different evaluations. If the pain intensity score was >= 4 (moderate or severe pain) at any time, the block was considered failed. General anesthesia was induced with 30 mu g/kg alfentanil and 2 mg/kg propofol, followed by propofol maintanance, plus remifentanil if needed. Postoperative analgesia supplementation was performed with dipyroneketoprofen and tramadol were given if needed. Data Measurements: The following parameters were evaluated: numerical pain intensity score, duration of analgesia, supplementary analgesic dose in 24 hours, and need for intraoperative remifentanil. Results: The EC50 was 0.160 (95% CI: 0.150 - 0.189), and EC90 was 0.271 (95% CI: 0.196 - 0.300). There was no difference in numerical pain intensity score for the different concentrations of bupivacaine. A successful block was achieved in 45 patients, with no difference according to bupivacaine concentration. Time to first analgesic supplementation dose was longer for bupivacaine concentrations >= 0.3% (543.8 +/- 283.8 min.), compared to 0.25% (391.3 +/- 177.8 min.) and < 0.25% (302.3 +/- 210.1 min.). There were no differences in supplementary analgesic dose in 24 hours nor in the use of intraoperative remifentanil according to bupivacaine concentration. Limitations: The analgesic effect was measured only during the first 2 hours. Conclusions: Bupivacaine EC50 for ultrasound-guided femoral nerve block was 0.160 (95% CI: 0.150 - 0.189), and EC90 was 0.271 (95% CI: 0.196 - 0.300).Department of Anesthesia,Universidade Federal de São Paulo, Rue Tres de Maio – 61/51 Sao Paulo, BrazilDepartment of Anesthesia,Universidade Federal de São Paulo, Rue Tres de Maio – 61/51 Sao Paulo, BrazilWeb of ScienceAm soc interventional pain physicians2019-01-21T10:30:12Z2019-01-21T10:30:12Z2016info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionE79-E86http://www.painphysicianjournal.com/linkout?issn=1533-3159&vol=19&page=E79Pain Physician. Paducah, v. 19, n. 1, p. E79-E86, 2016.1533-3159http://repositorio.unifesp.br/handle/11600/49632WOS:000368990800005engPain Physicianinfo:eu-repo/semantics/openAccessRey Moura, Ed Carlos [UNIFESP]de Oliveira Honda, Claudio Alex [UNIFESP]Teixeira Bringel, Roberto Cesar [UNIFESP]Leal, Plinio da Cunha [UNIFESP]Lopes Filho, Gasper de Jesus [UNIFESP]Sakata, Rioko Kinmiko [UNIFESP]reponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESP2021-10-05T22:12:43Zoai:repositorio.unifesp.br/:11600/49632Repositório InstitucionalPUBhttp://www.repositorio.unifesp.br/oai/requestbiblioteca.csp@unifesp.bropendoar:34652021-10-05T22:12:43Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)false
dc.title.none.fl_str_mv Minimum effective concentration of bupivacaine in ultrasound-guided femoral nerve block after arthroscopic knee meniscectomy: a randomized, double-blind, controlled trial
title Minimum effective concentration of bupivacaine in ultrasound-guided femoral nerve block after arthroscopic knee meniscectomy: a randomized, double-blind, controlled trial
spellingShingle Minimum effective concentration of bupivacaine in ultrasound-guided femoral nerve block after arthroscopic knee meniscectomy: a randomized, double-blind, controlled trial
Rey Moura, Ed Carlos [UNIFESP]
Postoperative Analgesia
Femoral Block
Ultrasound-Guided
Bupivacaine Minimum Concentration
Arthroscopic MeniscectomyPostoperative Analgesia
Intrathecal Morphine
Spinal-Anesthesia
Down Method
Arthroplasty
Volume
Ropivacaine
Volunteers
Pain
title_short Minimum effective concentration of bupivacaine in ultrasound-guided femoral nerve block after arthroscopic knee meniscectomy: a randomized, double-blind, controlled trial
title_full Minimum effective concentration of bupivacaine in ultrasound-guided femoral nerve block after arthroscopic knee meniscectomy: a randomized, double-blind, controlled trial
title_fullStr Minimum effective concentration of bupivacaine in ultrasound-guided femoral nerve block after arthroscopic knee meniscectomy: a randomized, double-blind, controlled trial
title_full_unstemmed Minimum effective concentration of bupivacaine in ultrasound-guided femoral nerve block after arthroscopic knee meniscectomy: a randomized, double-blind, controlled trial
title_sort Minimum effective concentration of bupivacaine in ultrasound-guided femoral nerve block after arthroscopic knee meniscectomy: a randomized, double-blind, controlled trial
author Rey Moura, Ed Carlos [UNIFESP]
author_facet Rey Moura, Ed Carlos [UNIFESP]
de Oliveira Honda, Claudio Alex [UNIFESP]
Teixeira Bringel, Roberto Cesar [UNIFESP]
Leal, Plinio da Cunha [UNIFESP]
Lopes Filho, Gasper de Jesus [UNIFESP]
Sakata, Rioko Kinmiko [UNIFESP]
author_role author
author2 de Oliveira Honda, Claudio Alex [UNIFESP]
Teixeira Bringel, Roberto Cesar [UNIFESP]
Leal, Plinio da Cunha [UNIFESP]
Lopes Filho, Gasper de Jesus [UNIFESP]
Sakata, Rioko Kinmiko [UNIFESP]
author2_role author
author
author
author
author
dc.contributor.author.fl_str_mv Rey Moura, Ed Carlos [UNIFESP]
de Oliveira Honda, Claudio Alex [UNIFESP]
Teixeira Bringel, Roberto Cesar [UNIFESP]
Leal, Plinio da Cunha [UNIFESP]
Lopes Filho, Gasper de Jesus [UNIFESP]
Sakata, Rioko Kinmiko [UNIFESP]
dc.subject.por.fl_str_mv Postoperative Analgesia
Femoral Block
Ultrasound-Guided
Bupivacaine Minimum Concentration
Arthroscopic MeniscectomyPostoperative Analgesia
Intrathecal Morphine
Spinal-Anesthesia
Down Method
Arthroplasty
Volume
Ropivacaine
Volunteers
Pain
topic Postoperative Analgesia
Femoral Block
Ultrasound-Guided
Bupivacaine Minimum Concentration
Arthroscopic MeniscectomyPostoperative Analgesia
Intrathecal Morphine
Spinal-Anesthesia
Down Method
Arthroplasty
Volume
Ropivacaine
Volunteers
Pain
description Background: Adequate analgesia is important for early hospital discharge after meniscectomy. A femoral nerve block may reduce the need for systemic analgesics, with fewer side effects
publishDate 2016
dc.date.none.fl_str_mv 2016
2019-01-21T10:30:12Z
2019-01-21T10:30:12Z
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://www.painphysicianjournal.com/linkout?issn=1533-3159&vol=19&page=E79
Pain Physician. Paducah, v. 19, n. 1, p. E79-E86, 2016.
1533-3159
http://repositorio.unifesp.br/handle/11600/49632
WOS:000368990800005
url http://www.painphysicianjournal.com/linkout?issn=1533-3159&vol=19&page=E79
http://repositorio.unifesp.br/handle/11600/49632
identifier_str_mv Pain Physician. Paducah, v. 19, n. 1, p. E79-E86, 2016.
1533-3159
WOS:000368990800005
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv Pain Physician
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv E79-E86
dc.publisher.none.fl_str_mv Am soc interventional pain physicians
publisher.none.fl_str_mv Am soc interventional pain physicians
dc.source.none.fl_str_mv reponame:Repositório Institucional da UNIFESP
instname:Universidade Federal de São Paulo (UNIFESP)
instacron:UNIFESP
instname_str Universidade Federal de São Paulo (UNIFESP)
instacron_str UNIFESP
institution UNIFESP
reponame_str Repositório Institucional da UNIFESP
collection Repositório Institucional da UNIFESP
repository.name.fl_str_mv Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)
repository.mail.fl_str_mv biblioteca.csp@unifesp.br
_version_ 1814268461608599552

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