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BJA Advance Access published online on February 24, 2009
British Journal of Anaesthesia, doi:10.1093/bja/aep010
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2009. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Determination of the EC50 of levobupivacaine for femoral and sciatic perineural infusion after total knee arthroplasty

G. A. McLeod1,*, J. Dale1,5, D. Robinson2, M. Checketts1, M. O. Columb3, J. Luck1,6, C. Wigderowitz2 and D. Rowley2,4

1 University Department of Anaesthesia and
2 University Department of Orthopaedics, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
3 Acute Block Intensive Care Unit, University Hospital of South Manchester, Wythenshawe, UK
4 Royal College of Surgeons of Edinburgh, Edinburgh EH8 9DW, UK

* Corresponding author. E-mail: g.a.mcleod{at}dundee.ac.uk

Background: Infusion of local anaesthetic through femoral and sciatic catheters is an accepted method of providing pain relief after knee arthroplasty. However, the minimum effective concentration of perineural local anaesthetics is not known.

Methods: Twenty-four patients received femoral and sciatic perineural infusions of levobupivacaine in order to prevent pain relief after total knee arthroplasty. The primary endpoint of the study was patient request for analgesic rescue for anterior or posterior knee pain within the first 36 h of perineural infusion. Treatment was determined by the method of sequential allocation, with a dosing interval of 0.002% w/v.

Results: Thirteen patients did not require rescue analgesia for anterior knee pain and 16 patients did not require rescue analgesia for posterior knee pain. Median duration of failed blocks until rescue analgesia was 25 h (24–27 h) for the femoral block and 27 h (24–29 h) for the sciatic block. The minimum concentration at which patients did not require rescue analgesia was 0.024% for the femoral nerve and 0.014% for the sciatic nerve. Comparison of EC50 showed that local anaesthetic requirements were significantly (P=0.03) higher by a factor of 1.25 (95% CI 1.03–1.55) for the femoral compared with the sciatic nerve.

Conclusions: The EC50 for femoral perineural infusion is greater than the EC50 for sciatic perineural infusion.

Keywords: anaesthetic techniques, regional, knee; anaesthetics local; pain, postoperative

5 Present address: Bristol Royal Infirmary, Bristol, Somerset BS2 8HW, UK

6 Present address: Golden Jubilee Hospital, Clydebank G81 4HX, UK


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[Abstract] [Full Text] [PDF]

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Determination of EC50 of Levobupivacaine for Femoral and Sciatic perineural infusion after Total Knee Arthroplasty
Anil Kumar Gupta
British Journal of Anaesthesia, 7 May 2009 [Full text]
Femoral and sciatic perineural infusion after total knee arthroplasty
Graeme A McLeod
British Journal of Anaesthesia, 7 Aug 2009 [Full text]

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