| JOURNAL HOME | CME HOME | THIS MONTH | PAST ISSUES | ETOC | COLLECTIONS |
| AUTHORS | REVIEWERS | EDITORIAL BOARD | FEEDBACK | RSS | HELP |
| ||||||||||||||
| ||||||||||||||
|
|
|
|
||||||||||||
|
||||||||||||||
Department of Anesthesia and Intensive Care Medicine, Lapeyronie University Hospital, Montpellier, France
Address correspondence and reprint requests to Xavier Capdevila, MD, PhD, Département d’Anesthésie Réanimation A, Hôpital Lapeyronie, 371 Avenue du Doyen Giraud, 34295 Montpellier, France. Address e-mail to x-capdevila{at}chu-montpellier.fr
Continuous three-in-one block is widely used for postoperative analgesia after proximal lower limb surgery, but location of the catheter has not been well addressed in the literature. We prospectively studied, in 100 patients, the characteristics of catheter threading under the iliac fascia and the correlations between catheter tip location and effective sensory and motor blockade of the three principal nerves of the lumbar plexus. Postoperatively, in conscious patients, 16 to 20 cm of a catheter was placed in the fascial sheath after femoral nerve location with a nerve stimulator. Contrast media (3 mL Iopamidol 390®) was injected, and the catheter tip was located by means of an anteroposterior pelvic radiograph. An equal-volume mixture of 0.5% bupivacaine/2% lidocaine with epinephrine (30 mL) was injected through the catheter. Patient and catheter-insertion characteristics were noted. Thirty minutes after injection, sensory blockade was evaluated in the cutaneous territories of the lateral femoral cutaneous, femoral, and obturator nerves, along with motor blockade of the last two nerves. Pain scores at 30 min were also recorded. Seven block failures were noted. The tip of the catheter reached the lumbar plexus (Group 1) in 23% of the patients and lay deep to the medial (Group 2) or lateral (Group 3) part of the fascia iliaca in 33% and 37% of the patients, respectively. Demographic data and catheter threading characteristics were comparable among the groups. A three-in-one block was noted in 91% of Group 1 patients, but in only 52% and 27% of Group 2 and 3 patients, respectively (P < 0.05). Comparing Group 2 and 3 patients, sensory block was achieved in respectively 100% and 94% for the femoral nerve, 52% and 94% for the lateral femoral cutaneous nerve (P < 0.05), and 82% and 27% for the obturator nerve (P < 0.05). Visual analog scale pain scores on movement were significantly lower in Group 1 patients (P < 0.05). We conclude that during a continuous three-in-one block, the threaded catheter rarely reached the lumbar plexus. The quality of sensory and motor blockade and initial pain relief depend on the location of the catheter tip under the fascia iliaca.
IMPLICATIONS: The course of a continuous three-in-one block catheter is unpredictable. Only 23% of the catheters lie near the lumbar plexus. The success of sensory and motor blocks, as well as postoperative analgesia, depend on the position of the catheter under the fascia iliaca.
This article has been cited by other articles:
|
|
 |
|
  I. Tanoubi, P. Cuvillon, E. Nouvellon, L. P. Fortier, P. Drolet, and J. Ripart Etude de cas : Anesthesie locoregionale sciatique et femorale bilaterale chez un polytraumatise: [Case report: Bilateral femoral and sciatic regional anesthesia in a polytraumatized patient] Can J Anesth, June 1, 2008; 55(6): 371 - 375. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. J. Barrington, D. J. Olive, C. A. McCutcheon, C. Scarff, S. Said, R. Kluger, N. Gillett, and P. Choong Stimulating Catheters for Continuous Femoral Nerve Blockade After Total Knee Arthroplasty: A Randomized, Controlled, Double-Blinded Trial Anesth. Analg., April 1, 2008; 106(4): 1316 - 1321. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Valade, J. Ripart, E. Nouvellon, P. Cuvillon, D. Prat-Pradal, J.-Y. Lefrant, and J.-E. de La Coussaye Does Sciatic Parasacral Injection Spread to the Obturator Nerve? An Anatomic Study Anesth. Analg., February 1, 2008; 106(2): 664 - 667. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. M. Hayek, R. M. Ritchey, D. Sessler, R. Helfand, S. Samuel, M. Xu, M. Beven, D. Bourdakos, W. Barsoum, and P. Brooks Continuous Femoral Nerve Analgesia After Unilateral Total Knee Arthroplasty: Stimulating Versus Nonstimulating Catheters Anesth. Analg., December 1, 2006; 103(6): 1565 - 1570. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. J. van Geffen and M. Gielen Ultrasound-guided subgluteal sciatic nerve blocks with stimulating catheters in children: a descriptive study. Anesth. Analg., August 1, 2006; 103(2): 328 - 33, table of contents. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Birnbaum, T. Volk, N. Jack, E. Liem, and L. Vonhogen Use of a stimulating catheter for femoral nerve block Br. J. Anaesth., January 1, 2006; 96(1): 139 - 140. [Full Text] [PDF]
|
|
|
|
|
|
H. Jutzi, S. Blumehthal, and A. Borgeat Ropivacaine 0.5% administered via a femoral catheter: is the obturator nerve also blocked? Can J Anesth, January 1, 2006; 53(1): 109 - 110. [Full Text] [PDF]
|
|
|
|
|
|
A. Weber, R. Fournier, and Z. Gamulin REPLY Can J Anesth, January 1, 2006; 53(1): 110 - 110. [Full Text] [PDF]
|
|
|
|
|
|
J. Rodriguez, M. Taboada, J. Carceller, J. Lagunilla, M. Barcena, and J. Alvarez Stimulating Popliteal Catheters for Postoperative Analgesia After Hallux Valgus Repair Anesth. Analg., January 1, 2006; 102(1): 258 - 262. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Casati, G. Fanelli, Z. Koscielniak-Nielsen, G. Cappelleri, G. Aldegheri, G. Danelli, R. Fuzier, and F. Singelyn Using Stimulating Catheters for Continuous Sciatic Nerve Block Shortens Onset Time of Surgical Block and Minimizes Postoperative Consumption of Pain Medication After Halux Valgus Repair as Compared with Conventional Nonstimulating Catheters Anesth. Analg., October 1, 2005; 101(4): 1192 - 1197. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M. Morin, L. H. J. Eberhart, H. K. E. Behnke, S. Wagner, T. Koch, U. Wolf, W. Nau, C. Kill, G. Geldner, and H. Wulf Does Femoral Nerve Catheter Placement with Stimulating Catheters Improve Effective Placement? A Randomized, Controlled, and Observer-Blinded Trial Anesth. Analg., May 1, 2005; 100(5): 1503 - 1510. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Weber, R. Fournier, N. Riand, and Z. Gamulin Duration of analgesia is similar when 15, 20, 25 and 30 mL of ropivacaine 0.5% are administered via a femoral catheter: [La duree de l'analgesie est similaire quand 15, 20, 25 et 30 mL de ropivacaine a 0,5 % sont administres par un catheter femoral] Can J Anesth, April 1, 2005; 52(4): 390 - 396. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. R. Offerdahl, R. L. Lennon, and T. T. Horlocker Successful Removal of a Knotted Fascia Iliaca Catheter: Principles of Patient Positioning for Peripheral Nerve Catheter Extraction Anesth. Analg., November 1, 2004; 99(5): 1550 - 1552. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. F. White, T. Issioui, G. D. Skrivanek, J. S. Early, and C. Wakefield The Use of a Continuous Popliteal Sciatic Nerve Block After Surgery Involving the Foot and Ankle: Does It Improve the Quality of Recovery? Anesth. Analg., November 1, 2003; 97(5): 1303 - 1309. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
X. Capdevila, P. Macaire, P. Aknin, C. Dadure, N. Bernard, and S. Lopez Patient-Controlled Perineural Analgesia After Ambulatory Orthopedic Surgery: A Comparison of Electronic Versus Elastomeric Pumps Anesth. Analg., February 1, 2003; 96(2): 414 - 417. [Abstract] [Full Text] [PDF]
|
|
|
