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MINERVA ANESTESIOLOGICA

Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva


Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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Minerva Anestesiologica 2018 Feb 05

DOI: 10.23736/S0375-9393.18.12291-7

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

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 1 , FJavier GONZÁLEZ 1, Sergi SABATÉ 2, Mercedes GARCÍA 1, Claudia LAMAS 3, Adrià FONT 1, Marisa MORENO 1, Ignasi PROUBASTA 3, M. Àngels GIL 1, M. Victoria MORAL 1, Rolf HOFFMANN 1

1 Department of Anaesthesiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; 2 Department of Anaesthesiology, Fundació Puigvert, Barcelona, Spain; 3 Department of Orthopaedic and Hand Surgery, Hospital Santa Creu i Sant Pau, Barcelona, Spain


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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 anaesthetic versus conventional systemic analgesia.
METHODS: Fifty-two patients undergoing trapeziectomy were randomized to receive levobupivacaine 0.125% 5ml 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% 20ml) 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 surgery - Pain, postoperative - Anesthesia, regional

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Publication History

Article first published online: February 05, 2018
Manuscript accepted: January 26, 2018
Manuscript revised: January 9, 2018
Manuscript received: July 7, 2017

Per citare questo articolo

Rodríguez M, González F, Sabaté S, García M, Lamas C, Font A, et al. Low-concentration distal nerve blocks with 0.125% levobupivacaine versus systemic analgesia for ambulatory trapeziectomy performed under axillary block: a randomized controlled trial. Minerva Anestesiol 2018 Feb 05. DOI: 10.23736/S0375-9393.18.12291-7

Corresponding author e-mail

mireiarodriguezprieto@gmail.com