Anesth Pain Med.  2020 Apr;15(2):209-216. 10.17085/apm.2020.15.2.209.

Analgesic effect of ropivacaine with fentanyl in comparison with ropivacaine alone for continuous femoral nerve block after knee replacement arthroplasty: a prospective, randomized, double-blinded study

• Kim GH
• Lee JW
• Kim GE
• Lee SS
• Son SL
• Kim BU
• Cho HN
• Kwon MY
• Koo MS
• Kim JE
• Yun MJ

• KMID: 2500974
• DOI: http://doi.org/10.17085/apm.2020.15.2.209

Abstract

Background
The analgesic effect of perineural opioid in clinical practice are still controversial. This randomized controlled trial compared analgesic effect of ropivacaine with fentanyl or ropivacaine alone for continuous femoral nerve block following unilateral total knee arthroplasty.
Methods
Fourty patients of ASA PS Ⅰ or Ⅱ receiving total knee arthroplasty with spinal anesthesia were enlisted and randomly allocated into two groups. Group R; bolus injection of 0.375% ropivacaine, 30 ml and an infusion of 0.2% ropivacaine at 8 ml/h (n = 20). Group RF; 0.375% ropivacaine, 29 ml added with 50 μg of fentanyl as a bolus and an infusion of 0.2% ropivacaine mixed with 1 μg/ml of fentanyl at 8 ml/h (n = 20). Local anesthetic infusion via a femoral nerve catheter was started at the end of operation and continued for 48 h. Intravenous patient-controlled analgesia with hydromorphone (0.15 mg/ml, 0-1-10) were used for adjuvant analgesics. Position of catheter tip and contrast distribution, visual analog scale of pain, hydromorphone consumption, side effects were recorded for 48 h after operation. Patient satisfaction for the pain control received were noted.
Results
The pain visual analogue scale, incidences of side effects and satisfaction were not different between the two groups (P > 0.05), but the hydromorphone usage at 48 h after operation were lower in the Group RF than in the Group R (P = 0.047).
Conclusions
The analgesic effect of ropivacaine with fentanyl for continuous femoral nerve block after knee replacement arthroplasty was not superior to that of the ropivacaine alone.

Keyword

Analgesia; Block; Femoral; Fentanyl; Nerve; Ropivacaine

Figure

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  Fig. 1. The position of catheter tip (type 2 = lateral, lateral to sacroiliac joint, cranial to hip joint, open arrow).

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  Fig. 2. The distribution of contrast dye (type 5 = loculated at unknown anatomic location, possible far from nerve sheath, open arrow).

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