PT  - JOURNAL ARTICLE
AU  - Eledjam, Jean Jacques
AU  - Cuvillon, Philippe
AU  - Capdevila, Xavier
AU  - Macaire, Philippe
AU  - Serri, Sylvain
AU  - Gaertner, Elisabeth
AU  - Jochum, Denis
TI  - Postoperative Analgesia by Femoral Nerve Block With Ropivacaine 0.2% After Major Knee Surgery: Continuous Versus Patient-Controlled Techniques
AID  - 10.1053/rapm.2002.36454
DP  - 2002 Nov 01
TA  - Regional Anesthesia & Pain Medicine
PG  - 604--611
VI  - 27
IP  - 6
4099  - http://rapm.bmj.com/content/27/6/604.short
4100  - http://rapm.bmj.com/content/27/6/604.full
SO  - Reg Anesth Pain Med2002 Nov 01; 27
AB  - 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.