FOOT & ANKLE
The effects of adding epinephrine to ropivacaine for popliteal nerve block on the duration of postoperative analgesia: a randomized controlled trial
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by one or more authors of the
original publication.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2015;3(19):7 BMC Anesthesiol. 2015 Jul 10;15:10038 patients patients scheduled for ankle fusion and/or subtalar fusion under continuous popliteal sciatic nerve block were randomized to receive 30 mL ropivacaine (0.75%) with or without the addition of epinephrine (5 ug/mL). The purpose of the study was to determine how the duration of postoperative analgesia was affected by the addition of epinephrine, as measured by the time elapsed from poplitear catheter placement until the time of first request for postoperative analgesia via patient controlled analgesia. Results indicated that the duration of postoperative analgesia was not significantly increased with the addition of epinephrine to ropivacaine for continuous popliteal nerve block.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
はい = 1
不確実＝0.5
無関係 = 0
いいえ = 0
報告基準評価では、著者が出版物内で試験の方法論的特徴や試験特性を報告する際の透明性を評価します。評価は以下の5つのカテゴリーに分類されます。
3/4
Randomization
4/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Fragility Indexは、重要な所見の解釈を助けるツールで、結果の強さの尺度を提供します。Fragility Indexは、その所見が有意でなくなるために、二項対立の結果に追加する必要がある連続した事象の数を表します。数値が小さいほど弱い所見を表し、数値が大きいほど強い所見を表します。
なぜ今この研究が必要なのですか？
Peripheral nerve block is often used for analgesia in ankle surgery. While the choice of local anaesthetic agent used in popliteal nerve blocks impacts efficacy, it has been suggested that so too does the addition of epinephrine. The theory behind the addition of epinephrine to local anaesthetic is to reduce local plasma concentration via vasoconstriction and slow absorption, thereby increasing the duration of analgesia. The current literature was limited in relation to this treatment, and thus the present study was conducted.
主な研究課題は何ですか？
In ankle and subtalar fusion under popliteal nerve block, how does time to first request for postoperative anaglesia compare between blocks performed with 30 mL ropivacaine (0.75%), with and without the addition of epinephrine?
重要な知見は？
- Median [interquartile range] TTFR for postoperative analgesia was 463 [300-1197] min in the ROPI group and 830 [397-1128] min in the ROPI-EPI group; the difference between groups in TTFR was not statistically significant (p=0.56).
- There was no significant difference noted between groups in terms of NRS rest at 24 h (p=0.70), NRS movement at 24 h (p=0.47), NRS max during 24 h (p=0.17), or NRS satisfaction with the block (p=0.08).
- In the ROPI group, 4 patients received complete block in tibial sensory, 10 in tibial motor, 12 in peroneal sensory, and 11 in peroneal motor. In the ROPI-EPI group, 9 patients received complete block in tibial sensory, 9 in tibial motor, 11 in peroneal sensory, and 10 in peroneal motor.
- No patients displayed signs of local anesthetic toxicity or inadvertent intravascular injection of epinephrine.
最も覚えておくべきことは？
Duration of postoperative analgesia, as measured by the time to first request for postoperative analgesia, was not significantly increased via the addition of epinephrine to ropivacaine for popliteal nerve block in ankle and/or subtalar fusion. Additionally, no significant differences were noted in any clinical outcome between the group receiving epinephrine and the group that did not.
それが私の患者ケアにどのように影響するか？
The results of this study indicate that the addition of epinephrine to ropivacaine treatment in popliteal nerve block may not significantly increase the duration of postoperative analgesia. Further high quality evidence, including larger sample sizes, is required before firm decisions regarding the use of epinephrine in this treatment are made in the clinical field.
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