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• W2512990122 abstract "A continuous peripheral nerve blockade has proved benefits on reducing postoperative morphine consumption; the combination of a femoral blockade and general anesthesia on reducing intraoperative anesthetic requirements has not been studied. The objective of this study was to determine the relevance of timing in the performance of femoral block to intraoperative anesthetic requirements during general anesthesia for total knee arthroplasty. A single-center, prospective cohort study on patients scheduled for total knee arthroplasty, were sequentially allocated to receive 20 mL of 2% mepivacaine throughout a femoral catheter, prior to anesthesia induction (Preoperative) or when skin closure started (Postoperative). An algorithm based on bispectral values guided intraoperative anesthetic management. Postoperative analgesia was done with an elastomeric pump of levobupivacaine 0.125% connected to the femoral catheter and complemented with morphine patient control analgesia for 48 hours. The Kruskall Wallis and the chi-square tests were used to compare variables. Statistical significance was set at p < 0.05. There were 94 patients, 47 preoperative and 47 postoperative. Lower fentanyl and sevoflurane were needed intraoperatively in the Preoperative group; median values and range: 250 (100–600) vs 450 (200–600) μg and 21 (12–48) vs 32 (18–67) mL p = 0.001, respectively. There were no differences in the median verbal numeric rating scale values 4 (0–10) vs 3 (0–10); and in median morphine consumption 9 (2–73) vs 8 (0–63) mg postoperatively. A preoperative femoral blockade is useful in decreasing anesthetic requirements in total knee arthroplasty surgery but no added effect in the postoperative analgesic control. O bloqueio contínuo de nervos periféricos provou ser benéfico para reduzir o consumo de morfina no pós-operatório. A combinação de um bloqueio femoral e anestesia geral para reduzir a necessidade de anestésicos no intraoperatório ainda não foi avaliada. O objetivo deste estudo foi determinar a relevância do momento propício durante a realização do bloqueio femoral para a necessidade de anestésicos no intraoperatório durante a anestesia geral para artroplastia total de joelho (ATJ). Estudo prospectivo de coorte de pacientes agendados para ATJ. Os pacientes foram sequencialmente alocados em grupos para receber mepivacaína a 2% (20 mL) durante a inserção do cateter femoral, antes da indução da anestesia (pré-operatório) ou no início do fechamento da pele (pós-operatório). Um algoritmo com base nos valores do BIS orientou o manejo da anestesia no intraoperatório. Analgesia no pós-operatório foi administrada via bomba elastomérica de levobupivacaína a 0,125% conectada ao cateter femoral e complementada com analgesia (morfina) controlada pelo paciente durante 48 horas. Os testes de Kruskall Wallis e do qui-quadrado foram usados para comparar as variáveis. A significância estatística foi estabelecida em p < 0,05. Foram estudados 94 pacientes, 47 no pré-operatório e 47 no pós-operatório. Houve menos necessidade de fentanil e sevoflurano durante o período intraoperatório no grupo pré-operatório; medianas e variações dos valores: 250 (100–600) vs. 450 (200–600) μg e 21 (12–48) vs. 32 (18–67) mL p = 0,001, respectivamente. Não houve diferenças nas medianas dos valores das escalas de classificação numérica e verbal, 4 (0–10) vs. 3 (0–10), e nas medianas do consumo de morfina, 9 (2–73) vs. 8 (0–63) mg no pós-operatório. O bloqueio femoral no pré-operatório é útil para diminuir a necessidade de anestésicos em ATJ, mas não tem efeito adicional no controle da analgesia no pós-operatório." @default.
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• W2512990122 date "2017-09-01" @default.
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• W2512990122 title "Anesthetic requirements measured by bilateral bispectral analysis and femoral blockade in total knee arthroplasty" @default.
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• W2512990122 doi "https://doi.org/10.1016/j.bjane.2016.07.013" @default.
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