Comparison of Three Techniques for Ultrasound-guided Femoral Nerve Catheter Insertion: A Randomized, Blinded Trial

BACKGROUND:Ultrasound guidance for continuous femoral perineural catheters may be supplemented by electrical stimulation through a needle or through a stimulating catheter. The authors tested the primary hypothesis that ultrasound guidance alone is noninferior on both postoperative pain scores and o...

Full description

Saved in:
Bibliographic Details
Published in:Anesthesiology (Philadelphia) 2014-08, Vol.121 (2), p.239-248
Main Authors: Farag, Ehab, Atim, Abdulkadir, Ghosh, Raktim, Bauer, Maria, Sreenivasalu, Thilak, Kot, Michael, Kurz, Andrea, Dalton, Jarrod E, Mascha, Edward J, Mounir-Soliman, Loran, Zaky, Sherif, Ali Sakr Esa, Wael, Udeh, Belinda L, Barsoum, Wael, Sessler, Daniel I
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Analgesics, Opioid - administration & dosage
Analgesics, Opioid - therapeutic use
Anesthesia
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Arthroplasty, Replacement, Knee - methods
Biological and medical sciences
Catheterization - economics
Catheterization - methods
Cost Control
Costs and Cost Analysis
Electric Stimulation
Female
Femoral Nerve - diagnostic imaging
Humans
Male
Medical sciences
Middle Aged
Morphine - administration & dosage
Morphine - therapeutic use
Needles
Nerve Block - economics
Nerve Block - methods
Pain Management
Pain Measurement - drug effects
Pain, Postoperative - prevention & control
Sample Size
Treatment Outcome
Ultrasonography, Interventional - methods
Young Adult
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:BACKGROUND:Ultrasound guidance for continuous femoral perineural catheters may be supplemented by electrical stimulation through a needle or through a stimulating catheter. The authors tested the primary hypothesis that ultrasound guidance alone is noninferior on both postoperative pain scores and opioid requirement and superior on at least one of the two. Second, the authors compared all interventions on insertion time and incremental cost. METHODS:Patients having knee arthroplasty with femoral nerve catheters were randomly assigned to catheter insertion guided by(1) ultrasound alone (n = 147); (2) ultrasound and electrical stimulation through the needle (n = 152); or (3) ultrasound and electrical stimulation through both the needle and catheter (n = 138). Noninferiority between any two interventions was defined for pain as not more than 0.5 points worse on a 0 to 10 verbal response scale and for opioid consumption as not more than 25% greater than the mean. RESULTS:The stimulating needle group was significantly noninferior to the stimulating catheter group (difference [95% CI] in mean verbal response scale pain score [stimulating needle vs. stimulating catheter] of −0.16 [−0.61 to 0.29], P < 0.001; percentage difference in mean IV morphine equivalent dose of −5% [−25 to 21%], P = 0.002) and to ultrasound-only group (difference in mean verbal response scale pain score of −0.28 [−0.72 to 0.16], P < 0.001; percentage difference in mean IV morphine equivalent dose of −2% [−22 to 25%], P = 0.006). In addition, the use of ultrasound alone for femoral nerve catheter insertion was faster and cheaper than the other two methods. CONCLUSION:Ultrasound guidance alone without adding either stimulating needle or needle/catheter combination thus seems to be the best approach to femoral perineural catheters.
ISSN:0003-3022
1528-1175
DOI:10.1097/ALN.0000000000000262