Patient-Titrated Automated Intermittent Boluses of Local Anesthetic vs. a Continuous Infusion Via a Perineural Catheter for Postoperative Analgesia

Launched by UNIVERSITY OF CALIFORNIA, SAN DIEGO · Oct 21, 2021

Keywords

ClinConnect Summary

This is a randomized study looking at two ways to give nerve-area pain medicine (ropivacaine) after foot/ankle or arm surgery that uses small tubes near the nerves (perineural catheters). One group receives a steady drip plus small, patient-activated extra doses (continuous infusion with patient-controlled boluses). The other group gets automatic, timed bursts of medicine with a pause after discharge, plus the same patient-controlled doses. The study will look separately at two catheter locations: near the nerves of the leg (popliteal-sciatic) and near the nerves of the shoulder/arm (infraclavicular). The main questions are whether the new intermittent-bolus method provides at least as good pain relief as the steady infusion, and whether it keeps the catheter in use for a longer total time. Researchers will also track daily pain scores, how many opioids you take, sleep, mood, activity, and overall satisfaction with the analgesia.

To be eligible, adults 18 and older must be having the specified surgeries with a planned infraclavicular or popliteal-sciatic catheter for postoperative pain control. Key exclusions include using daily opioids in the last 4 weeks, existing nerve problems in the treated area, very high BMI (over 35), certain surgeries outside the targeted nerve areas, pregnancy, or incarceration. If you join, you’ll have the catheter connected to a pump after surgery and will be contacted by phone for 9 days to report pain and how pain affects daily life. The trial is being conducted at UC San Diego and is currently enrolling, with results not yet available.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • - patients undergoing ulnar and/or radial fracture open reduction internal fixation or painful foot and/or ankle surgery with a planned infraclavicular or popliteal sciatic perineural catheter, respectively, for postoperative analgesia
• Exclusion Criteria:
• • daily opioid use within the previous 4 weeks
• • clinical neuro-muscular deficit of either the brachial plexus (infraclavicular) or sciatic nerve (sciatic catheters) and its branches and/or innervating muscles
• • morbid obesity \[body mass index \> 35 kg/m2\]
• • surgery outside of the ipsilateral sciatic and saphenous nerve distributions for sciatic catheters \[e.g., iliac crest bone graft\]
• • pregnancy
• • incarceration