Lateral femoral cutaneous nerve block with different volumes of Ropivacaine: a randomized trial in healthy volunteers

Frederik Vilhelmsen*, Mariam Nersesjan, Jakob Hessel Andersen, Jakob Klim Danker, Leif Broeng, Daniel Hägi-Pedersen, Ole Mathiesen, Kasper Højgaard Thybo

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

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Abstract

BACKGROUND: Nerve block of the lateral femoral cutaneous nerve (LFCN) is a predominantly sensory block. It reduces pain following total hip arthroplasty (THA), but the non-responder rate is high. We hypothesized, that an increased volume of ropivacaine, would result in greater coverage of incisions used for THA.

METHODS: We conducted a randomized, blinded trial in 20 healthy volunteers. Participants were randomized to receive bilateral LFCN-blocks with 8 mL ropivacaine 0.75% on the left side and 16 mL ropivacaine 0.75% on the right side, or vice versa. Allocation was blinded to both participants and outcome assessors. Before nerve block performance, incision lines for posterior and lateral THA approaches were depicted with invisible ultraviolet-paint, thereby securing sufficient blinding during outcome assessment. The blocked area was mapped using temperature and mechanical discrimination tests. Quadriceps muscle strength was monitored. Primary outcome was coverage of the posterior incision line assessed by temperature discrimination test.

RESULTS: We found no difference in coverage of the posterior or lateral incision lines when comparing LFCN-blocks with 8 mL versus 16 mL of ropivacaine. The blocked area was significantly larger in the 16 mL group, assessed by both temperature discrimination test (p = 0.012) and mechanical discrimination test (p = 0.034). We observed no difference between groups regarding quadriceps muscle strength (p = 1.0).

CONCLUSIONS: A LFCN-block with increased volume of ropivacaine from 8 mL to 16 mL did not result in a greater coverage of posterior or lateral incision lines used for THA, but in a larger blocked sensory area.

TRIAL REGISTRATION: Clinicaltrials.gov: NCT03138668 . Registered 3rd of May 2017.

Original languageEnglish
Article number165
JournalBMC Anesthesiology
Volume19
Number of pages8
ISSN1471-2253
DOIs
Publication statusPublished - 28. Aug 2019

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Femoral Nerve
Hip
Skin
Quadriceps Muscle
Outcome Assessment (Health Care)

Keywords

  • Anatomy
  • Clinical trial
  • Lateral femoral cutaneous nerve block
  • Regional anesthetics
  • Ropivacaine
  • Total hip arthroplasty

Cite this

Vilhelmsen, Frederik ; Nersesjan, Mariam ; Andersen, Jakob Hessel ; Danker, Jakob Klim ; Broeng, Leif ; Hägi-Pedersen, Daniel ; Mathiesen, Ole ; Thybo, Kasper Højgaard. / Lateral femoral cutaneous nerve block with different volumes of Ropivacaine : a randomized trial in healthy volunteers. In: BMC Anesthesiology. 2019 ; Vol. 19.
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title = "Lateral femoral cutaneous nerve block with different volumes of Ropivacaine: a randomized trial in healthy volunteers",
abstract = "BACKGROUND: Nerve block of the lateral femoral cutaneous nerve (LFCN) is a predominantly sensory block. It reduces pain following total hip arthroplasty (THA), but the non-responder rate is high. We hypothesized, that an increased volume of ropivacaine, would result in greater coverage of incisions used for THA.METHODS: We conducted a randomized, blinded trial in 20 healthy volunteers. Participants were randomized to receive bilateral LFCN-blocks with 8 mL ropivacaine 0.75{\%} on the left side and 16 mL ropivacaine 0.75{\%} on the right side, or vice versa. Allocation was blinded to both participants and outcome assessors. Before nerve block performance, incision lines for posterior and lateral THA approaches were depicted with invisible ultraviolet-paint, thereby securing sufficient blinding during outcome assessment. The blocked area was mapped using temperature and mechanical discrimination tests. Quadriceps muscle strength was monitored. Primary outcome was coverage of the posterior incision line assessed by temperature discrimination test.RESULTS: We found no difference in coverage of the posterior or lateral incision lines when comparing LFCN-blocks with 8 mL versus 16 mL of ropivacaine. The blocked area was significantly larger in the 16 mL group, assessed by both temperature discrimination test (p = 0.012) and mechanical discrimination test (p = 0.034). We observed no difference between groups regarding quadriceps muscle strength (p = 1.0).CONCLUSIONS: A LFCN-block with increased volume of ropivacaine from 8 mL to 16 mL did not result in a greater coverage of posterior or lateral incision lines used for THA, but in a larger blocked sensory area.TRIAL REGISTRATION: Clinicaltrials.gov: NCT03138668 . Registered 3rd of May 2017.",
keywords = "Anatomy, Clinical trial, Lateral femoral cutaneous nerve block, Regional anesthetics, Ropivacaine, Total hip arthroplasty",
author = "Frederik Vilhelmsen and Mariam Nersesjan and Andersen, {Jakob Hessel} and Danker, {Jakob Klim} and Leif Broeng and Daniel H{\"a}gi-Pedersen and Ole Mathiesen and Thybo, {Kasper H{\o}jgaard}",
year = "2019",
month = "8",
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doi = "10.1186/s12871-019-0833-4",
language = "English",
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Lateral femoral cutaneous nerve block with different volumes of Ropivacaine : a randomized trial in healthy volunteers. / Vilhelmsen, Frederik; Nersesjan, Mariam; Andersen, Jakob Hessel; Danker, Jakob Klim; Broeng, Leif; Hägi-Pedersen, Daniel; Mathiesen, Ole; Thybo, Kasper Højgaard.

In: BMC Anesthesiology, Vol. 19, 165, 28.08.2019.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Lateral femoral cutaneous nerve block with different volumes of Ropivacaine

T2 - a randomized trial in healthy volunteers

AU - Vilhelmsen, Frederik

AU - Nersesjan, Mariam

AU - Andersen, Jakob Hessel

AU - Danker, Jakob Klim

AU - Broeng, Leif

AU - Hägi-Pedersen, Daniel

AU - Mathiesen, Ole

AU - Thybo, Kasper Højgaard

PY - 2019/8/28

Y1 - 2019/8/28

N2 - BACKGROUND: Nerve block of the lateral femoral cutaneous nerve (LFCN) is a predominantly sensory block. It reduces pain following total hip arthroplasty (THA), but the non-responder rate is high. We hypothesized, that an increased volume of ropivacaine, would result in greater coverage of incisions used for THA.METHODS: We conducted a randomized, blinded trial in 20 healthy volunteers. Participants were randomized to receive bilateral LFCN-blocks with 8 mL ropivacaine 0.75% on the left side and 16 mL ropivacaine 0.75% on the right side, or vice versa. Allocation was blinded to both participants and outcome assessors. Before nerve block performance, incision lines for posterior and lateral THA approaches were depicted with invisible ultraviolet-paint, thereby securing sufficient blinding during outcome assessment. The blocked area was mapped using temperature and mechanical discrimination tests. Quadriceps muscle strength was monitored. Primary outcome was coverage of the posterior incision line assessed by temperature discrimination test.RESULTS: We found no difference in coverage of the posterior or lateral incision lines when comparing LFCN-blocks with 8 mL versus 16 mL of ropivacaine. The blocked area was significantly larger in the 16 mL group, assessed by both temperature discrimination test (p = 0.012) and mechanical discrimination test (p = 0.034). We observed no difference between groups regarding quadriceps muscle strength (p = 1.0).CONCLUSIONS: A LFCN-block with increased volume of ropivacaine from 8 mL to 16 mL did not result in a greater coverage of posterior or lateral incision lines used for THA, but in a larger blocked sensory area.TRIAL REGISTRATION: Clinicaltrials.gov: NCT03138668 . Registered 3rd of May 2017.

AB - BACKGROUND: Nerve block of the lateral femoral cutaneous nerve (LFCN) is a predominantly sensory block. It reduces pain following total hip arthroplasty (THA), but the non-responder rate is high. We hypothesized, that an increased volume of ropivacaine, would result in greater coverage of incisions used for THA.METHODS: We conducted a randomized, blinded trial in 20 healthy volunteers. Participants were randomized to receive bilateral LFCN-blocks with 8 mL ropivacaine 0.75% on the left side and 16 mL ropivacaine 0.75% on the right side, or vice versa. Allocation was blinded to both participants and outcome assessors. Before nerve block performance, incision lines for posterior and lateral THA approaches were depicted with invisible ultraviolet-paint, thereby securing sufficient blinding during outcome assessment. The blocked area was mapped using temperature and mechanical discrimination tests. Quadriceps muscle strength was monitored. Primary outcome was coverage of the posterior incision line assessed by temperature discrimination test.RESULTS: We found no difference in coverage of the posterior or lateral incision lines when comparing LFCN-blocks with 8 mL versus 16 mL of ropivacaine. The blocked area was significantly larger in the 16 mL group, assessed by both temperature discrimination test (p = 0.012) and mechanical discrimination test (p = 0.034). We observed no difference between groups regarding quadriceps muscle strength (p = 1.0).CONCLUSIONS: A LFCN-block with increased volume of ropivacaine from 8 mL to 16 mL did not result in a greater coverage of posterior or lateral incision lines used for THA, but in a larger blocked sensory area.TRIAL REGISTRATION: Clinicaltrials.gov: NCT03138668 . Registered 3rd of May 2017.

KW - Anatomy

KW - Clinical trial

KW - Lateral femoral cutaneous nerve block

KW - Regional anesthetics

KW - Ropivacaine

KW - Total hip arthroplasty

U2 - 10.1186/s12871-019-0833-4

DO - 10.1186/s12871-019-0833-4

M3 - Journal article

C2 - 31455249

VL - 19

JO - B M C Anesthesiology

JF - B M C Anesthesiology

SN - 1471-2253

M1 - 165

ER -