Comparison of three techniques for ultrasound-guided femoral nerve catheter insertion: A randomized, blinded trial

Ehab Farag, Abdulkadir Atim, Raktim Ghosh, Maria Bauer, Thilak Sreenivasalu, Michael Kot, Andrea Kurz, Jarrod E. Dalton, Edward J. Mascha, Loran Mounir-Soliman, Sherif Zaky, Wael Ali Sakr Esa, Belinda L. Udeh, Wael Barsoum, Daniel I. Sessler

Research output: Contribution to journalArticle

Abstract

BACKGROUND:: Ultrasound guidance for continuous femoral perineural catheters may be supplemented by electrical stimulation through a needle or through a stimulating catheter. The authors tested the primary hypothesis that ultrasound guidance alone is noninferior on both postoperative pain scores and opioid requirement and superior on at least one of the two. Second, the authors compared all interventions on insertion time and incremental cost. METHODS:: Patients having knee arthroplasty with femoral nerve catheters were randomly assigned to catheter insertion guided by: (1) ultrasound alone (n = 147); (2) ultrasound and electrical stimulation through the needle (n = 152); or (3) ultrasound and electrical stimulation through both the needle and catheter (n = 138). Noninferiority between any two interventions was defined for pain as not more than 0.5 points worse on a 0 to 10 verbal response scale and for opioid consumption as not more than 25% greater than the mean. RESULTS:: The stimulating needle group was significantly noninferior to the stimulating catheter group (difference [95% CI] in mean verbal response scale pain score [stimulating needle vs. stimulating catheter] of -0.16 [-0.61 to 0.29], P < 0.001; percentage difference in mean IV morphine equivalent dose of -5% [-25 to 21%], P = 0.002) and to ultrasound-only group (difference in mean verbal response scale pain score of -0.28 [-0.72 to 0.16], P < 0.001; percentage difference in mean IV morphine equivalent dose of -2% [-22 to 25%], P = 0.006). In addition, the use of ultrasound alone for femoral nerve catheter insertion was faster and cheaper than the other two methods. CONCLUSION:: Ultrasound guidance alone without adding either stimulating needle or needle/catheter combination thus seems to be the best approach to femoral perineural catheters.

Original languageEnglish (US)
Pages (from-to)239-248
Number of pages10
JournalAnesthesiology
Volume121
Issue number2
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

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Femoral Nerve
Catheters
Needles
Electric Stimulation
Thigh
Pain
Morphine
Opioid Analgesics
Knee Replacement Arthroplasties
Postoperative Pain

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Comparison of three techniques for ultrasound-guided femoral nerve catheter insertion : A randomized, blinded trial. / Farag, Ehab; Atim, Abdulkadir; Ghosh, Raktim; Bauer, Maria; Sreenivasalu, Thilak; Kot, Michael; Kurz, Andrea; Dalton, Jarrod E.; Mascha, Edward J.; Mounir-Soliman, Loran; Zaky, Sherif; Ali Sakr Esa, Wael; Udeh, Belinda L.; Barsoum, Wael; Sessler, Daniel I.

In: Anesthesiology, Vol. 121, No. 2, 01.01.2014, p. 239-248.

Research output: Contribution to journalArticle

Farag, E, Atim, A, Ghosh, R, Bauer, M, Sreenivasalu, T, Kot, M, Kurz, A, Dalton, JE, Mascha, EJ, Mounir-Soliman, L, Zaky, S, Ali Sakr Esa, W, Udeh, BL, Barsoum, W & Sessler, DI 2014, 'Comparison of three techniques for ultrasound-guided femoral nerve catheter insertion: A randomized, blinded trial', Anesthesiology, vol. 121, no. 2, pp. 239-248. https://doi.org/10.1097/ALN.0000000000000262
Farag, Ehab ; Atim, Abdulkadir ; Ghosh, Raktim ; Bauer, Maria ; Sreenivasalu, Thilak ; Kot, Michael ; Kurz, Andrea ; Dalton, Jarrod E. ; Mascha, Edward J. ; Mounir-Soliman, Loran ; Zaky, Sherif ; Ali Sakr Esa, Wael ; Udeh, Belinda L. ; Barsoum, Wael ; Sessler, Daniel I. / Comparison of three techniques for ultrasound-guided femoral nerve catheter insertion : A randomized, blinded trial. In: Anesthesiology. 2014 ; Vol. 121, No. 2. pp. 239-248.
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abstract = "BACKGROUND:: Ultrasound guidance for continuous femoral perineural catheters may be supplemented by electrical stimulation through a needle or through a stimulating catheter. The authors tested the primary hypothesis that ultrasound guidance alone is noninferior on both postoperative pain scores and opioid requirement and superior on at least one of the two. Second, the authors compared all interventions on insertion time and incremental cost. METHODS:: Patients having knee arthroplasty with femoral nerve catheters were randomly assigned to catheter insertion guided by: (1) ultrasound alone (n = 147); (2) ultrasound and electrical stimulation through the needle (n = 152); or (3) ultrasound and electrical stimulation through both the needle and catheter (n = 138). Noninferiority between any two interventions was defined for pain as not more than 0.5 points worse on a 0 to 10 verbal response scale and for opioid consumption as not more than 25{\%} greater than the mean. RESULTS:: The stimulating needle group was significantly noninferior to the stimulating catheter group (difference [95{\%} CI] in mean verbal response scale pain score [stimulating needle vs. stimulating catheter] of -0.16 [-0.61 to 0.29], P < 0.001; percentage difference in mean IV morphine equivalent dose of -5{\%} [-25 to 21{\%}], P = 0.002) and to ultrasound-only group (difference in mean verbal response scale pain score of -0.28 [-0.72 to 0.16], P < 0.001; percentage difference in mean IV morphine equivalent dose of -2{\%} [-22 to 25{\%}], P = 0.006). In addition, the use of ultrasound alone for femoral nerve catheter insertion was faster and cheaper than the other two methods. CONCLUSION:: Ultrasound guidance alone without adding either stimulating needle or needle/catheter combination thus seems to be the best approach to femoral perineural catheters.",
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T1 - Comparison of three techniques for ultrasound-guided femoral nerve catheter insertion

T2 - A randomized, blinded trial

AU - Farag, Ehab

AU - Atim, Abdulkadir

AU - Ghosh, Raktim

AU - Bauer, Maria

AU - Sreenivasalu, Thilak

AU - Kot, Michael

AU - Kurz, Andrea

AU - Dalton, Jarrod E.

AU - Mascha, Edward J.

AU - Mounir-Soliman, Loran

AU - Zaky, Sherif

AU - Ali Sakr Esa, Wael

AU - Udeh, Belinda L.

AU - Barsoum, Wael

AU - Sessler, Daniel I.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - BACKGROUND:: Ultrasound guidance for continuous femoral perineural catheters may be supplemented by electrical stimulation through a needle or through a stimulating catheter. The authors tested the primary hypothesis that ultrasound guidance alone is noninferior on both postoperative pain scores and opioid requirement and superior on at least one of the two. Second, the authors compared all interventions on insertion time and incremental cost. METHODS:: Patients having knee arthroplasty with femoral nerve catheters were randomly assigned to catheter insertion guided by: (1) ultrasound alone (n = 147); (2) ultrasound and electrical stimulation through the needle (n = 152); or (3) ultrasound and electrical stimulation through both the needle and catheter (n = 138). Noninferiority between any two interventions was defined for pain as not more than 0.5 points worse on a 0 to 10 verbal response scale and for opioid consumption as not more than 25% greater than the mean. RESULTS:: The stimulating needle group was significantly noninferior to the stimulating catheter group (difference [95% CI] in mean verbal response scale pain score [stimulating needle vs. stimulating catheter] of -0.16 [-0.61 to 0.29], P < 0.001; percentage difference in mean IV morphine equivalent dose of -5% [-25 to 21%], P = 0.002) and to ultrasound-only group (difference in mean verbal response scale pain score of -0.28 [-0.72 to 0.16], P < 0.001; percentage difference in mean IV morphine equivalent dose of -2% [-22 to 25%], P = 0.006). In addition, the use of ultrasound alone for femoral nerve catheter insertion was faster and cheaper than the other two methods. CONCLUSION:: Ultrasound guidance alone without adding either stimulating needle or needle/catheter combination thus seems to be the best approach to femoral perineural catheters.

AB - BACKGROUND:: Ultrasound guidance for continuous femoral perineural catheters may be supplemented by electrical stimulation through a needle or through a stimulating catheter. The authors tested the primary hypothesis that ultrasound guidance alone is noninferior on both postoperative pain scores and opioid requirement and superior on at least one of the two. Second, the authors compared all interventions on insertion time and incremental cost. METHODS:: Patients having knee arthroplasty with femoral nerve catheters were randomly assigned to catheter insertion guided by: (1) ultrasound alone (n = 147); (2) ultrasound and electrical stimulation through the needle (n = 152); or (3) ultrasound and electrical stimulation through both the needle and catheter (n = 138). Noninferiority between any two interventions was defined for pain as not more than 0.5 points worse on a 0 to 10 verbal response scale and for opioid consumption as not more than 25% greater than the mean. RESULTS:: The stimulating needle group was significantly noninferior to the stimulating catheter group (difference [95% CI] in mean verbal response scale pain score [stimulating needle vs. stimulating catheter] of -0.16 [-0.61 to 0.29], P < 0.001; percentage difference in mean IV morphine equivalent dose of -5% [-25 to 21%], P = 0.002) and to ultrasound-only group (difference in mean verbal response scale pain score of -0.28 [-0.72 to 0.16], P < 0.001; percentage difference in mean IV morphine equivalent dose of -2% [-22 to 25%], P = 0.006). In addition, the use of ultrasound alone for femoral nerve catheter insertion was faster and cheaper than the other two methods. CONCLUSION:: Ultrasound guidance alone without adding either stimulating needle or needle/catheter combination thus seems to be the best approach to femoral perineural catheters.

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