Comparison of Single-Agent Versus 3-Additive Regional Anesthesia for Foot and Ankle Surgery.

Autor:	Dang DY; Saint Alphonsus Regional Medical Center Coughlin Clinic, Boise, ID, USA., McGarry SM; Oregon Anesthesia Group PC, Portland, OR, USA., Melbihess EJ; Boise Anesthesia, Boise, ID, USA., Haytmanek CT; The Steadman Clinic, Vail, CO, USA., Stith AT; Wyoming Orthopaedics and Sports Medicine, Cheyenne, WY, USA., Griffin MJ; Synergy Orthopaedic Specialists Medical Group, San Diego, CA, USA., Ackerman KJ; Pacific Northwest University of Health Sciences, Yakima, WA, USA., Hirose CB; Saint Alphonsus Regional Medical Center Coughlin Clinic, Boise, ID, USA.
Jazyk:	angličtina
Zdroj:	Foot & ankle international [Foot Ankle Int] 2019 Oct; Vol. 40 (10), pp. 1195-1202. Date of Electronic Publication: 2019 Jul 16.
DOI:	10.1177/1071100719859020
Abstrakt:	Background: This study compared the results of regional blocks containing a single anesthetic, bupivacaine, with those containing bupivacaine and 3 additives (buprenorphine, clonidine, and dexamethasone) in patients undergoing foot and ankle surgery. Methods: Eighty patients undergoing foot and ankle surgery over a 9-month period were prospectively enrolled and randomized to receive a peripheral nerve block containing either a single anesthetic (SA) or one with 3 additives (TA). Patients, surgeons, and anesthesiologists were blinded to the groups. Patients maintained pain diaries and were evaluated at 1 and 12 weeks postoperatively. Fifty-six patients completed the study. Results: The TA group had a longer duration of analgesic effect than the SA group (average 82 vs 34 hours, P < .05). Forty-eight hours after surgery, 93% of SA blocks, compared with 34% of TA blocks, had completely worn off. The TA group had a longer duration of sensory effects. At 3 months, 10 of 26 (38.5%) TA patients, compared with 3 of 30 (10%) SA patients, reported postoperative neurologic symptoms. Pain scores in both groups were not statistically different at 1 week or 3 months after surgery. Patients in both groups were similarly satisfied with their blocks. Conclusion: Both types of nerve blocks provided equivalent pain control and patient satisfaction in patients undergoing foot and ankle surgery. The 3-additive agent blocks were associated with a longer duration of pain relief and a longer duration of numbness, as well as higher rates of postoperative neurologic symptoms. Longer pain relief may be obtained at the cost of prolonged sensory deficits. Level of Evidence: Level II, prospective comparative study.
Databáze:	MEDLINE
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