ORIGINAL ARTICLE   Free

Minerva Anestesiologica 2018 November;84(11):1261-9

DOI: 10.23736/S0375-9393.18.12291-7

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Low-concentration distal nerve blocks with 0.125% levobupivacaine versus systemic analgesia for ambulatory trapeziectomy performed under axillary block: a randomized controlled trial

Mireia RODRÍGUEZ PRIETO ¹ ✉, F. Javier GONZÁLEZ ¹, Sergi SABATÉ ², Mercedes GARCÍA ¹, Claudia LAMAS ³, Adrià FONT ¹, Marisa MORENO ¹, Ignasi PROUBASTA ³, M. Àngels GIL DE BERNABÉ ¹, M. Victoria MORAL ¹, Rolf HOFFMANN ¹

¹ Department of Anesthesiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; ² Department of Anesthesiology, Puigvert Foundation, Barcelona, Spain; ³ Department of Orthopedic and Hand Surgery, Hospital Santa Creu i Sant Pau, Barcelona, Spain

BACKGROUND: Trapeziectomy is one of the most painful procedures in ambulatory surgery. This prospective randomized trial aimed to compare postoperative pain control using distal peripheral nerve blocks (dPNB) with a low concentration of a long-acting local anesthetic versus conventional systemic analgesia.
METHODS: Fifty-two patients undergoing trapeziectomy were randomized to receive levobupivacaine 0.125% 5 mL on radial and median nerves at the elbow (dNB group), or not to receive these blocks (control group). In both groups, surgery was performed under axillary block (mepivacaine 1% 20 mL) and the same analgesic regimen was prescribed at discharge. The primary outcome was postoperative pain at 24 and 48 hours after surgery and maximum pain score on the first and second postoperative day. Secondary outcomes were duration of dPNB, rescue analgesia requirements, opioid-related side effects, consumption and effectiveness of antiemetic therapy, and upper limb motor block.
RESULTS: Fifty patients were analyzed. Maximum pain intensity was moderate to severe (dPNB vs. control) in 33.3% vs. 92.3% (P=0.002) on the first day after surgery and 20.8% vs. 80.8% (P<0.001) on the second day. The average duration of analgesia after dPNB was 10 hours and no patient reported motor block. dPNB reduced rescue analgesia requirements and the incidence of postoperative nausea and vomiting (PONV).
CONCLUSIONS: dPNB on target nerves provided better analgesia than systemic analgesia after trapeziectomy performed under axillary block. Opioid consumption and the incidence of PONV were lower in the dPNB group.

KEY WORDS: Ambulatory surgical procedures - Pain, postoperative - Anesthesia, regional