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Intentional lateral epidural catheter placement for anterior cruciate ligament reconstruction
Author(s) -
Dauri M.,
Sidiropoulou T.,
Fabbi E.,
Mariani P. P.,
Sabato A. F.
Publication year - 2005
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.2005.00692.x
Subject(s) - medicine , ropivacaine , anesthesia , sufentanil , catheter , urinary retention , surgery , local anesthetic , hemodynamics , analgesic , anesthetic , adverse effect , orthopedic surgery , bupivacaine
Background: Unilateral epidural block might constitute a clinical option in lower limb orthopedic surgery. Methods: Seventy‐five patients undergoing anterior cruciate ligament reconstruction (ACLR) were randomized to either a laterally directed epidural catheter (IUEC, n = 40) or a classic midline catheter (CMEC, n = 35). Paresthesia encountered during catheter insertion was registered. The start dose of the anesthetic mixture clonidine 60 µg (0.4 ml), sufentanil 15 µg (0.3 ml) and ropivacaine 10 mg ml −1 (10.3 ml) in 11 ml of total volume) was set at 5 ml and was increased by 2 ml if anesthesia was inadequate after assessment for sensory blockade to cold and pin‐prick. Data were registered intra‐ and postoperatively regarding pain scores as well as motor block, hemodynamic parameters, adverse effects and need for supplemental analgesia other than a continuous postoperative epidural infusion. Results: In the IUEC group 80% of patients reported a light paresthesia of the affected side during catheter insertion, whereas 71% of patients in the CMEC group reported no paresthesia at all. The amount of anesthetic used to establish surgical anesthesia was lower in the IUEC group (6.2 ± 0.8 vs. 8 ± 1.9 ml, P < 0.001). Motor block (Bromage score) of the unaffected side was significantly lower in the IUEC group ( P < 0.001). Pain intensity scores, hemodynamic parameters, and supplemental analgesia given were similar between the two groups except for VAS scores at 12 h postoperatively, which were higher in the CMEC group ( P < 0.01). Urinary retention was significantly more frequent in the CMEC group (19/35 vs. 5/40, P < 0.001). Conclusion: These results suggest that the IUEC technique is a feasible and efficient method for providing anesthesia and analgesia for ACLR and is associated with a lower consume of anesthetics, less motor block and a reduced incidence of urinary retention.