Addition of epinephrine to popliteal nerve block does not extend analgesia in ankle fusion .
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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)?
Sim = 1
Incerto = 0,5
Não relevante = 0
Não = 0
A Avaliação dos Critérios de Relato avalia a transparência com que os autores relatam as caraterísticas metodológicas e do ensaio na publicação. A avaliação está dividida em cinco categorias que são apresentadas de seguida.
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
O Índice de Fragilidade é uma ferramenta que auxilia na interpretação de achados significativos, fornecendo uma medida de força para um resultado. O Índice de Fragilidade representa o número de eventos consecutivos que precisam de ser adicionados a um resultado dicotómico para que o resultado deixe de ser significativo. Um número pequeno representa um resultado mais fraco e um número grande representa um resultado mais forte.
Porque é que este estudo era necessário agora?
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.
Qual era a principal questão de investigação?
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?
- 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.
De que é que me devo lembrar mais?
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.
Como é que isto afectará o tratamento dos meus doentes?
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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