Ilio inguinal block: do we know the correct dose?

No Abstract. Southern African Journal of Anaesthesia and Analgesia Vol. 12(1) 2006: 37-3

Comparative efficacy of ultrasound-guided and stimulating popliteal-sciatic perineural catheters for postoperative analgesia

Perineural catheter insertion using ultrasound guidance alone is a relatively new approach. Previous studies have shown that ultrasound-guided catheters take less time to place with high placement success rates, but the analgesic efficacy compared with the established stimulating catheter technique remains unknown. We tested the hypothesis that popliteal-sciatic perineural catheter insertion relying exclusively on ultrasound guidance results in superior postoperative analgesia compared with stimulating catheters. Preoperatively, subjects receiving a popliteal-sciatic perineural catheter for foot or ankle surgery were assigned randomly to either ultrasound guidance (bolus via needle with non-stimulating catheter insertion) or electrical stimulation (bolus via catheter). We used 1.5% mepivacaine 40 mL for the primary surgical nerve block and 0.2% ropivacaine (basal 8 mL·hr−1; bolus 4 mL; 30 min lockout) was infused postoperatively. The primary outcome was average surgical pain on postoperative day one. Forty of the 80 subjects enrolled were randomized to each treatment group. One of 40 subjects (2.5%) in the ultrasound group failed catheter placement per protocol vs nine of 40 (22.5%) in the stimulating catheter group (P = 0.014). The difference in procedural duration (mean [95% confidence interval (CI)]) was −6.48 (−9.90 - −3.05) min, with ultrasound requiring 7.0 (4.0-14.1) min vs stimulation requiring 11.0 (5.0-30.0) min (P < 0.001). The average pain scores of subjects who provided data on postoperative day one were somewhat higher for the 33 ultrasound subjects than for the 26 stimulation subjects (5.0 [1.0-7.8] vs 3.0 [0.0-6.5], respectively; P = 0.032), a difference (mean [95%CI]) of 1.37 (0.03-2.71). For popliteal-sciatic perineural catheters, ultrasound guidance takes less time and results in fewer placement failures compared with stimulating catheters. However, analgesia may be mildly improved with successfully placed stimulating catheters. Clinical trial registration number NCT00876681

Regionalanästhesie im klinischen Alltag: eine ökonomische Analyse anhand eines Versorgungsbeispiels

Die Gesundheitsausgaben in den meisten Ländern steigen stetig, trotzdem werden fundierte wissenschaftliche Artikel zum Thema Medizinökonomie selten publiziert. Dies gilt auch für das Fachgebiet der Anästhesie sowie deren Subspezialitäten. Insbesondere die Regionalanästhesie hat sich hier während der letzten Jahre kontinuierlich weiterentwickelt, und die Implementierung des Ultraschalls hat zur Effizienzsteigerung auf diesem Gebiet entscheidend beigetragen. Der vorliegende Artikel analysiert anhand von 3 Fallvignetten (anästhesiologische Versorgung einer Unterarmfraktur in suffizienter Regionalanästhesie, Allgemeinnarkose und insuffizienter Regionalanästhesie) die ökonomischen Implikationen der verschiedenen anästhesiologischen Verfahren. Entsprechende Maßnahmen zur erfolgreichen ökonomisch orientierten Implementierung der Regionalanästhesie in den klinischen Alltag werden in diesem Artikel besprochen. The economic effect is a crucial aspect of every medical procedure. This article analyzes the economic implications of various methods in anesthesia based on three case vignettes. Methods The management of anesthesia of a forearm fracture with sufficient brachial plexus blockade, general anesthesia and insufficient brachial plexus blockade with subsequent general anesthesia was analyzed with respect to the relevant cost factors (personnel costs, durables, consumables, fixed assets costs, anesthesia-related overhead costs). Results Sufficient regional anesthesia was the least expensive method for a forearm fracture with 324.26 €, followed by general anesthesia with 399.18 € (+23% compared with regional anesthesia). Insufficient regional anesthesia was most the expensive method, which necessitated an additional general anesthesia (482.55 €, +49% compared with sufficient regional anesthesia). Conclusion Even considering that this cost analysis was calculated based on data from only one medical institution (General Hospital of Vienna, Medical University of Vienna), regional anesthesia appeared to be cost efficient compared with other anesthesia procedures. Main cost drivers in this example were personnel costs