Continuous femoral nerve blocks: varying local anesthetic delivery method (bolus versus basal) to minimize quadriceps motor block while maintaining sensory block

Abstract

Background: Whether the method of local anesthetic administration for continuous femoral nerve blocks--basal infusion versus repeated hourly bolus doses--influences block effects remains unknown.

Methods: Bilateral femoral perineural catheters were inserted in volunteers (n = 11). Ropivacaine 0.1% was concurrently administered through both catheters: a 6-h continuous 5 ml/h basal infusion on one side and 6 hourly bolus doses on the contralateral side. The primary endpoint was the maximum voluntary isometric contraction (MVIC) of the quadriceps femoris muscle at hour 6. Secondary endpoints included quadriceps MVIC at other time points, hip adductor MVIC, and cutaneous sensation 2 cm medial to the distal quadriceps tendon in the 22 h after initiation of local anesthetic administration.

Results: Quadriceps MVIC for limbs receiving 0.1% ropivacaine as a basal infusion declined by a mean (SD) of 84% (19) compared with 83% (24) for those receiving 0.1% ropivacaine as repeated bolus doses between baseline and hour 6 (paired t test P = 0.91). Intrasubject comparisons (left vs. right) also reflected a lack of difference: the mean basal-bolus difference in quadriceps MVIC at hour 6 was -1.1% (95% CI -22.0-19.8%). The similarity did not reach the a priori threshold for concluding equivalence, which was the 95% CI decreasing within ± 20%. There were similar minimal differences in the secondary endpoints during local anesthetic administration.

Conclusions: This study did not find evidence to support the hypothesis that varying the method of local anesthetic administration--basal infusion versus repeated bolus doses--influences continuous femoral nerve block effects to a clinically significant degree.

Fig. 1

Infusion apparatus allowing randomized, double-masked local anesthetic administration.

Fig. 2

Effects of femoral perineural local anesthetic administration method (basal-only vs. repeated boluses) on quadriceps femoris strength (mean [SE] illustrated). Statistically significant differences between treatments at 95% confidence are designated with an asterisk.

Fig. 3

Effects of femoral perineural local anesthetic administration method (basal-only vs. repeated boluses) on hip adductor strength (mean [SE] illustrated). The one statistically significant difference between treatments at 95% confidence is designated with an asterisk.

Fig. 4

Effects of femoral perineural local anesthetic administration method (basal-only vs. repeated boluses) on tolerance of transcutaneous electrical stimulation in the cutaneous distribution of the femoral nerve (mean [SE] illustrated). There were no statistically significant differences between treatments at 95% confidence.