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Femoral and sciatic perineural infusion after total knee arthroplasty
- Graeme A McLeod (7 August 2009)
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Determination of EC50 of Levobupivacaine for Femoral and Sciatic perineural infusion after Total Knee Arthroplasty
- Anil Kumar Gupta (7 May 2009)
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Graeme A McLeod
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In response to Dr Gupta, I apologise for the errors which he has kindly pointed out. An erratum has been sent to the editor and OUP. With regard to the statement that knee arthroplasty is “not highly emetogenic surgery”, I disagree. Recent studies1 2 of spinal anaesthesia with intrathecal morphine have shown an incidence of nausea and vomiting of 80% after knee arthroplasty. Our anaesthetic department follows the principals set out by Apfel et al3 towards the prevention of postoperative nausea and vomiting, and justifies our choice of three anti-emetics. With regard to pain, we care for all our arthroplasty patients within a single ward, and I am confident that the small team of nurses measures pain verbal rating scores well. In Scotland Health Care Assistants are not allowed to measure vital signs. I may add that the primary end point of the study was successful or unsuccessful pain relief defined as no demand or demand for perineural rescue within the 36 h study period. We regard time to first rescue analgesia as a logical end point in regional anaesthesia studies. 1. Rathmell JP, Pino CA, Taylor R, Patrin T, Viani BA. Intrathecal morphine for postoperative analgesia: a randomized, controlled, dose- ranging study after hip and knee arthroplasty. Anesth Analg 2003;97:1452- 7. 2. Sites BD, Beach M, Gallagher JD, Jarrett RA, Sparks MB, Lundberg CJ. A single injection ultrasound-assisted femoral nerve block provides side effect-sparing analgesia when compared with intrathecal morphine in patients undergoing total knee arthroplasty. Anesth Analg 2004;99:1539-43 3. Apfel CC, Korttila K, Abdalla M, Kerger H, Turan A, Vedder I, et al. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med 2004;350:2441-51 Conflict of Interest:None declared |
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Anil Kumar Gupta, consultant anaesthetist
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I read with interest the article by G.A Mcleod et al to determine the EC50 of Levobupivacaine for perineural infusion after total knee arthroplasty. It is a good study but there are few things I would like to point out. There are a number of errors like the dose of Cefuroxime is mentioned as 1.5 mg instead of 1.5gm; The plasma concentration of propofol for sedation is mentioned as 0.5mg/ml (I presume it is 0.5microgram/ml). The tuohy needle for Femoral block is mentioned as 50cm! instead of 50mm. For sciatic nerve block the length of the needle is mentioned as 100cm! I am surprised that all the patients were given Ondansetron, Cyclizine and Dexamethasone as prophylactic anti emetics despite the fact that this is not highly emetogenic surgery. Despite this 21% patients experienced nausea and vomiting. Was the use of prophylactic anti emetics really justified? Moreover the pain score assessment by ward nurses can be inaccurate depending on the experience of the nurse. A lot of times these observations are done by Health Care Assistants(Although I presume this was not the case in this study). The number of errors has highlighted that even good journals are not immune to some casual or poor reviewing of the articles before publishing Conflict of Interest:None declared |
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