Continuous infusion femoral nerve block versus placebo/no treatment

Table 10 Continuous infusion femoral nerve block versus placebo/no treatment: study details and qualitative outcomes














































































Study


N treatment/
control


Comparison


Supplemental


Analgesic


VAS Scores and type of pain, where specified


Time to first analgesic request


Use of supplemental analgesic


Other important outcomes


(Edwards, N. D. 1992) (LoE 1)


19/18


30 ml 0.25% bupivacaine into ipsilateral femoral nerve sheath after induction of anaesthesia, followed by continuous infusion of 0.125% bupivacaine at 6 ml/h for 24 h (Fem) vs. control (Cont)


Postop: IM papaveretum (10–20 mg) every 4 h, on request


Fem superior at the time points recorded (i.e. 4 and 24 h) (p<0.01, in both cases)


__


Number of papaveretum doses required in the 1st 24 h: Fem superior (p<0.01); total papaveretum dose in the 1st 24 h: Fem superior (p<0.01)


__


(Hirst 1996) (LoE 1)


11/11


Pre-op 20 ml 0.5% bupivacaine and 1:200000 epinephrine, postop continuous infusion 0.125% bupivacaine at 6 ml/h for 48 h (Fem) vs. “mock” femoral nerve blocks (Cont)


Postop: PCA-morphine, IV


Fem superior during passive flexion (30°) in recovery room (p<0.05); NS at other time points recorded (in the next 72 h)


__


Morphine requirements: NS during assessment period (i.e. over 1st 48 h postop)


PONV


Nausea: Fem superior at 24 and 48 h (p-values not reported)


(Kaloul 2004) 1st arm


(LoE 1)


20/20


Continuous femoral block with 30 ml 0.5% ropivacaine and 1:200000 epinephrine bolus, followed by infusion of 0.2% ropivacaine at 12 ml/h for 48 h (Fem) vs. control (Cont)


Postop: PCA-morphine, IV, for 48 h; additional oral analgesia: oxycodone, acetaminophen, codeine


At rest: Fem superior at 6 and 24 h (p<0.0001, in both cases), but NS at 48 h; during physical therapy: NS


__


0–48 h morphine consumption: Fem superior (p=0.0002)


__


(Kaloul 2004) 2nd arm


(LoE 1)


20/20


Continuous lumbar plexus block with 30 ml 0.5% ropivacaine and 1:200000 epinephrine bolus, followed by infusion of 0.2% ropivacaine at 12 ml/h for 48 h (Lumb) vs. control (Cont)


Postop: PCA-morphine, IV, for 48 h; additional oral analgesia: oxycodone, acetaminophen, codeine


At rest: Lumb superior at 6 and 24 h (p<0.0001, in both cases), but NS at 48 h; during physical therapy: NS


__


0–48 h morphine consumption: Lumb superior (p<0.0001)


__


(Ganapathy 1999)


(LoE 1)


20/22/20


 


Modified continuous femoral block with 30 ml, followed by infusion at 10 ml/h for 48 h: 0.1% bupivacaine (LowBup) vs. 0.2% bupivacaine (HighBup) vs. saline (Cont)


Postop: PCA-morphine, IV


At rest and during activity: NS, except on day of surgery, when both LowBup and HighBup superior to Cont (p<0.05, in all cases)


__


Morphine consumption: HighBup superior to control (p<0.05) during first 4 h postop and from 8 am to 8 pm on day 1, but not during the night of surgery; total morphine consumption and hourly morphine use: NS


PONV


NS


Functional Outcomes


ROM: HighBup superior on day 1 only (p<0.05)


(Serpell 1991)


(LoE 2)


13/16


Postop lumbar plexus block with 0.3 ml/kg 0.5% bupivacaine, with additional doses at 6-8 h intervals (Fem) vs. control (Cont)


Postop: PCA-morphine,IV; additionally, 10 mg IM morphine and 1 g oral paracetamol was available if required


NS at the time points recorded (i.e. at 24 and 48 h)


__


0–48 h: Fem superior (p<0.05); additional analgesia (oral/IM): NS


PONV


NS


(Singelyn 1998)


(LoE 1)


15/15


Continuous femoral block with 37 ml 0.25% bupivacaine and 1:200000 epinephrine, followed by infusion of 0.125% bupivacaine with0.1 ug/ml sufentanil and 1 ug/ml clonidine at 10 ml/h (Fem) vs. control (Cont)


Postop: 1 g IV paracetamol, followed by 10–20 mg IM piritramide if pain scores remained unchanged after 30 min


At rest: Fem superior at all time points (i.e. at 4, 24 and 48 h) (p<0.05, in all cases); on movement: Fem superior at 4 and 24 h (p<0.05, in both cases), but NS at 48 h


__


NS over 48 h postop


PONV


Nausea and/or vomiting: NS


Functional Outcomes


Flexion: Fem superior on day 1 (p=0.009), from day 2 to discharge (p<0.001) and at 6 weeks (p=0.03), but NS at 3 months; number of days required to obtain 90-degree flexion: Fem superior (p<0.001); number of patients discharged with <90-degree flexion: Fem superior (p=0.02); first ambulation: Fem superior (p=0.02)


Hospital stay


Length of hospital stay:


Fem superior (p<0.001)