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Departments of *Anesthesiology and
Orthopedic Surgery, Vita-Salute University of Milano, Instituto di Ricovero e Cura a Carattere Scientifico San Raffaele Hospital, Milan, Italy
Address correspondence and reprint requests to Andrea Casati, MD, Department of Anesthesiology, IRCCS H San Raffaele, Via Olgettina 60, 20132 Milan, Italy. Address e-mail to casati.andrea{at}hsr.it
In 60 patients receiving elective hallux valgus repair, we compared the efficacy of continuous popliteal sciatic nerve block produced with 0.2% ropivacaine (n = 20), 0.2% levobupivacaine (n = 20), or 0.125% levobupivacaine (n = 20) infused with a patient-controlled system starting 3 h after a 30-mL bolus of the 0.5% concentration of the study drug and for 48 h (baseline infusion rate, 6 mL/h; incremental dose, 2 mL; lockout time, 15 min; maximum incremental doses per hour, 3). No differences were reported in the intraoperative efficacy of the nerve block. The degree of pain was similar in the three groups throughout the study period, both at rest and during motion. Total consumption of local anesthetic solution during the first 24 h was 148 mL (range, 144–228 mL) with 0.2% ropivacaine, 150 mL (range, 144–200 mL) with 0.2% levobupivacaine, and 148 mL (range, 144–164 mL) with 0.125% levobupivacaine (P = 0.59). The volume of local anesthetic consumed during the second postoperative day was 150 mL (range, 144–164 mL) with 0.2% ropivacaine, 154 mL (range, 144–176 mL) with 0.2% levobupivacaine, and 151 mL (range, 144–216 mL) with 0.125% levobupivacaine (P = 0.14). A smaller proportion of patients receiving 0.2% levobupivacaine showed complete recovery of foot motor function as compared with 0.2% ropivacaine and 0.125% levobupivacaine, both at 24 h (35% vs 85% and 95%; P = 0.0005) and at 48 h (60% vs 100% and 100%; P = 0.001). We conclude that sciatic infusion with both 0.125% and 0.2% levobupivacaine provides adequate postoperative analgesia after hallux valgus repair, clinically similar to that provided by 0.2% ropivacaine; however, the 0.125% concentration is preferred if early mobilization of the operated foot is required.
IMPLICATIONS: Comparing 0.2% ropivacaine with 0.125% and 0.2% levobupivacaine for continuous lateral popliteal sciatic nerve block after hallux valgus repair, this prospective, randomized, double-blinded study demonstrated that both 0.125% and 0.2% levobupivacaine provide effective adequate postoperative analgesia without differences from that provided by 0.2% ropivacaine. If early mobilization of the operated foot is required, the 0.125% concentration of levobupivacaine is preferred rather than 0.2%.
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  F. Heid, N. Muller, T. Piepho, M. Bares, M. Giesa, P. Drees, A. Rumelin, and C. Werner Postoperative Analgesic Efficacy of Peripheral Levobupivacaine and Ropivacaine: A Prospective, Randomized Double-Blind Trial in Patients After Total Knee Arthroplasty Anesth. Analg., May 1, 2008; 106(5): 1559 - 1561. [Abstract] [Full Text] [PDF]
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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]
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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]
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