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Postoperative Analgesia by Femoral Nerve Block With Ropivacaine 0.2% After Major Knee Surgery: Continuous Versus Patient-Controlled Techniques
  1. Jean Jacques Eledjam, M.D.,
  2. Philippe Cuvillon, M.D.,
  3. Xavier Capdevila, M.D., Ph.D.,
  4. Philippe Macaire, M.D.,
  5. Sylvain Serri, M.D.,
  6. Elisabeth Gaertner, M.D. and
  7. Denis Jochum, M.D.
  1. From the Department of Anesthesiology, DAR B (J.J.E.), Montpellier, France; Department of Anesthesiology and Pain Management, Hôpital Gaston Doumergue (P.C.), Nıîmes, France; Department of Anesthesiology, DAR A (X.C.), Montpellier, France; Clinique du Parc (P.M.), Lyon, France; Clinique les Cigognes (S.S.), Besançon, France; Department of Anesthesiology, Hôpital Haute Pierre (E.G.), Strasbourg, France; and the Clinique du Diaconat (D.J.), Colmar, France.
  1. Reprint requests: Philippe Cuvillon, M.D., Département Anesthésie Douleur, Hôpital Gaston Doumergue, 5 rue Hôche, 30029 Nômes, France. E-mail:


Background and Objectives This prospective study compared the efficacy and adverse effects after knee surgery of ropivacaine 0.2% administered as patient-controlled femoral analgesia (PCFA), as a continuous femoral infusion (Inf), or as both (PCFA+Inf).

Methods Before general anesthesia, 140 adults scheduled to undergo major knee surgery received a sciatic/fascia iliaca nerve block with 0.75% ropivacaine (40 mL). After surgery, they were randomly assigned to receive, through the femoral catheter, an infusion of 0.2% ropivacaine administered as PCFA (boluses of 10 mL with a lockout time of 60 minutes), Inf (10 mL/h), or PCFA + Inf (5 mL/h plus boluses of 5 mL with a lockout time of 60 minutes). Pain was assessed at rest, on mobilization, and during physiotherapy using a visual analog scale (VAS). Additional use of intravenous (IV) analgesics was noted.

Results Patients in all 3 groups experienced similar pain relief at rest, on mobilization, and after physiotherapy (P > .05). Additional use of analgesics and overall patient satisfaction (excellent or good in 80% of cases) were also similar in all groups. However, total postoperative ropivacaine consumption was lower in the PCFA group, 150 mL/48 h (90.5 to 210); than in the Inf group, 480 mL/48 h (478 to 480); and the PCFA + Inf group, 310 mL/48 h (280 to 340) (P < .05). Adverse events were similar in all 3 groups (hypotension, vomiting, insomnia). No paresthesia or motor block were observed.

Conclusion All 3 strategies provided effective pain relief. PCFA resulted in a lower consumption of ropivacaine (toxic and financial impact). PCFA + Inf does not improve postoperative analgesia.

  • Pain relief
  • Local anesthetics
  • Peripheral nerve block

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  • Supported by AstraZeneca, Rueil-Malmaison Cedex, France.

    Presented in part at the French Annual Meeting of Société Française Anesthésie Reanimation, Paris, France, September 20-23, 2001, and at the Annual Meeting of European Society of Anesthesiologists, Nice, France, April 6-9, 2002.