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Prospective Comparison of Continuous Femoral Nerve Block with Nonstimulating Catheter Placement Versus Stimulating Catheter-Guided Perineural Placement in Volunteers
  1. Francis V Salinas, M.D.,
  2. Joseph M Neal, M.D.,
  3. Lila A Sueda, M.D.,
  4. Dan J Kopacz, M.D. and
  5. Spencer S Liu, M.D.
  1. From the Department of Anesthesiology, Virginia Mason Medical Center and University of Washington School of Medicine, Seattle, WA
  1. Reprint requests: Francis V. Salinas, M.D., Department of Anesthesiology, Virginia Mason Medical Center, 1100 9th Ave., B2-AN, Seattle, WA 98101 USA. E-mail: anefvs{at}vmmc.org

Abstract

Background and Objectives: Stimulating catheter-guided perineural placement may potentially increase the success rate and quality of continuous femoral nerve block as compared with a nonstimulating catheter technique. These hypotheses have not been rigorously tested.

Methods: Twenty volunteers underwent placement of bilateral femoral nerve catheters in this prospective, randomized, double-blind study. For each side, a stimulating needle was advanced until quadriceps contractions were obtained at ≤0.5 mA. On one side, a stimulating catheter was advanced 4 to 5 cm beyond the needle tip while eliciting quadriceps contractions via the catheter. If quadriceps contractions decreased or disappeared, the catheter position was adjusted until quadriceps contractions could be elicited at ≤0.5 mA. On the contralateral side, an identical catheter was advanced 4 to 5 cm beyond the needle tip without attempts to elicit quadriceps contractions via the catheter. After bolus injection of 10 mL lidocaine 1%, ropivacaine 0.2% at 10 mL/h was continuously infused through both catheters for 4 hours. Success of femoral block was defined as loss of sensation to cold and pinprick stimuli. Quality of successful block was determined by tolerance to transcutaneous electrical stimulation and force dynamometry of quadriceps strength.

Results: Block success was 100% via the stimulating catheters versus 85% via the nonstimulating catheters (P = .07). Overall tolerance to transcutaneous electrical stimulation (P = .009) and overall depth of motor block (P = .03) was significantly higher in the stimulating catheter-guided femoral nerve blocks.

Conclusions: In this volunteer study, there was no statistically significant difference in block success between the two techniques. However, stimulating catheter-guided placement provided an increased overall quality of continuous femoral perineural blockade. Further studies are needed to verify these observations in the clinical setting.

  • Continuous femoral nerve block
  • Peripheral stimulating catheters
  • Transcutaenous electrical stimulation

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Footnotes

  • David L. Brown, M.D., served as the Acting Editor-in-Chief for this article.

    This study was 1 of 4 chosen as “Best of Meeting” abstracts at the spring meeting of the American Society of Regional Anesthesia, March 11, 2004, Orlando, FL.

    Supported by the American Society of Regional Anesthesia Carl Koller Research Grant and an unrestricted research grant from Arrow International.

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