Table 10 Continuous infusion femoral nerve block versus placebo/no treatment: study details and qualitative outcomes
Study | N treatment/ | 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) | __ |
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) | PONVNausea: 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 | 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) |