PMID- 27920573
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200929
IS  - 1178-7090 (Print)
IS  - 1178-7090 (Electronic)
IS  - 1178-7090 (Linking)
VI  - 9
DP  - 2016
TI  - Femoral nerve blockade using various concentrations of local anesthetic for knee 
      arthroscopy in the pediatric population.
PG  - 1073-1079
AB  - BACKGROUND: Femoral nerve blockade (FNB) provides effective postoperative 
      analgesia in children undergoing arthroscopic knee surgery as evidenced by their 
      opioid-sparing effects and decreased postoperative pain scores. Increasing the 
      local anesthetic concentration in peripheral nerve blockade for adults undergoing 
      orthopedic surgery has been shown to be beneficial, increasing block success 
      rate, and providing a longer duration of analgesia. The effect of increasing the 
      concentration of local anesthetic in extremity blocks in children remains largely 
      unexplored. METHODS: We retrospectively evaluated the effectiveness of FNB using 
      three concentrations of local anesthetic (ropivacaine 0.2%, bupivacaine 0.25%, 
      and ropivacaine 0.5%) in children and adolescents undergoing arthroscopic knee 
      surgery. The primary outcome evaluated was postoperative opioid consumption 
      before discharge. Secondary outcomes included post-anesthesia care unit (PACU) 
      and hospital discharge times, first pain score in PACU, and the incidence of 
      adverse events. RESULTS: Two hundred and sixty-nine children and adolescents who 
      received a FNB for arthroscopic knee surgery from January 2010 to December 2013 
      were included for analysis. Local anesthetic used in FNB was ropivacaine 0.2% in 
      116 (43%) cases, ropivacaine 0.5% in 75 (28%) cases, and bupivacaine 0.25% in 78 
      (29%) cases. Median postoperative opioid consumption (mg/kg intravenous morphine 
      equivalents) in the ropivacaine 0.5% group was 0 mg/kg (interquartile ranges 
      [IQR]: 0 mg, 0.03 mg/kg) compared to 0.02 mg/kg (IQR: 0, 0.08 mg/kg) in the 
      ropivacaine 0.2% group and 0.01 mg/kg (IQR: 0, 0.08 mg/kg) in the bupivacaine 
      0.25% group (p=0.009). Median PACU time was shortest in the ropivacaine 0.5% 
      group (47 min; IQR: 36, 68 min) compared to the ropivacaine 0.2% (58 min; IQR: 
      41, 77) and bupivacaine 0.25% (54 min; IQR: 35, 75 min) groups (p=0.040). Among 
      groups, there were no significant differences in first postoperative pain scores 
      or incidence of nausea and vomiting. No patient in any group experienced a 
      serious adverse event. CONCLUSION: The results suggest that ropivacaine 0.5% for 
      FNB offers superior postoperative analgesia in the form of decreased 
      postoperative opioid consumption and earlier PACU/hospital discharge, when 
      compared to ropivacaine 0.2% and bupivacaine 0.25% in the pediatric population. 
      LEVEL OF EVIDENCE: III, Retrospective Comparative Study.
FAU - Veneziano, Giorgio
AU  - Veneziano G
AD  - Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital; 
      Department of Anesthesiology & Pain Medicine, The Ohio State University College 
      of Medicine.
FAU - Tripi, Jennifer
AU  - Tripi J
AD  - Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital.
FAU - Tumin, Dmitry
AU  - Tumin D
AD  - Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital.
FAU - Hakim, Mumin
AU  - Hakim M
AD  - Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital.
FAU - Martin, David
AU  - Martin D
AD  - Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital; 
      Department of Anesthesiology & Pain Medicine, The Ohio State University College 
      of Medicine.
FAU - Beltran, Ralph
AU  - Beltran R
AD  - Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital; 
      Department of Anesthesiology & Pain Medicine, The Ohio State University College 
      of Medicine.
FAU - Klingele, Kevin
AU  - Klingele K
AD  - Department of Orthopedic Surgery, Nationwide Children's Hospital; Department of 
      Orthopedic Surgery, The Ohio State University College of Medicine, Columbus, OH, 
      USA.
FAU - Bhalla, Tarun
AU  - Bhalla T
AD  - Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital; 
      Department of Anesthesiology & Pain Medicine, The Ohio State University College 
      of Medicine.
FAU - Tobias, Joseph D
AU  - Tobias JD
AD  - Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital; 
      Department of Anesthesiology & Pain Medicine, The Ohio State University College 
      of Medicine.
LA  - eng
PT  - Journal Article
DEP - 20161118
PL  - New Zealand
TA  - J Pain Res
JT  - Journal of pain research
JID - 101540514
PMC - PMC5125980
OTO - NOTNLM
OT  - adolescent
OT  - anesthesia
OT  - child
OT  - local anesthetic
OT  - nerve block
OT  - pain
OT  - postoperative
OT  - regional
COIS- The authors report no conflicts of interest in this work.
EDAT- 2016/12/07 06:00
MHDA- 2016/12/07 06:01
PMCR- 2016/11/18
CRDT- 2016/12/07 06:00
PHST- 2016/12/07 06:00 [entrez]
PHST- 2016/12/07 06:00 [pubmed]
PHST- 2016/12/07 06:01 [medline]
PHST- 2016/11/18 00:00 [pmc-release]
AID - jpr-9-1073 [pii]
AID - 10.2147/JPR.S117692 [doi]
PST - epublish
SO  - J Pain Res. 2016 Nov 18;9:1073-1079. doi: 10.2147/JPR.S117692. eCollection 2016.