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      Continuous Transversus Abdominis Plane Nerve Blocks: Does Varying Local Anesthetic Delivery Method—Automatic Repeated Bolus vs. Continuous Basal Infusion—Influence the Extent of Sensation to Cold? : A Randomized, Triple-Masked, Crossover Study in Volunteers

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          Abstract

          Background

          It remains unknown whether continuous or scheduled intermittent bolus local anesthetic administration is preferable for transversus abdominis plane (TAP) catheters. We therefore tested the hypothesis that when using TAP catheters, providing local anesthetic in repeated bolus doses increases the cephalad-caudad cutaneous effects compared with a basal-only infusion.

          Methods

          Bilateral TAP catheters (posterior approach) were inserted in 24 healthy volunteers followed by ropivacaine 2 mg/mL administration for a total of 6 hours. The right side was randomly assigned to either a basal infusion (8 mL/h) or bolus doses (24 mL administered every 3 hours for a total of 2 bolus doses) in a double-masked manner. The left side received the alternate treatment. The primary endpoint was the extent of sensory deficit as measured by cool roller along the axillary line at Hour 6 (6 hours after the local anesthetic administration was initiated). Secondary endpoints included the extent of sensory deficit as measured by cool roller and Von Frey filaments along the axillary line and along a transverse line at the level of the anterior superior iliac spine at Hours 0–6.

          Results

          While there were statistically significant differences between treatments within the earlier part of the administration period, by Hour 6 the difference in extent of sensory deficit to cold failed to reach statistical significance along the axillary line (mean=0.9 cm; SD=6.8; 95% CI −2.0, 3.8; p=0.515) and transverse line (mean=2.5 cm; SD=10.1; 95% CI −1.8, 6.8; p=0.244). While the difference between treatments was statistically significant at various early time points for the horizontal, vertical and estimated area measurements of both cold and mechanical pressure sensory deficits, no comparison remained statistically significant by Hour 6.

          Conclusion

          No evidence was found in this study involving healthy volunteers to support the hypothesis that changing the local anesthetic administration technique (continuous basal versus hourly bolus) when using ropivacaine 0.2% and TAP catheter at 8 mL/h and 24 mL every 3 hours significantly influences the cutaneous effects after 6 hours of administration. Additional research is required to determine whether changing variables (e.g., local anesthetic concentration, basal infusion rate, bolus dose volume and/or interval) would provide different results.

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          Author and article information

          Contributors
          Role: Assistant Clinical Professor
          Role: Assistant Clinical Professor
          Role: Assistant Clinical Professor
          Role: Assistant Clinical Professor
          Role: Assistant Clinical Professor
          Role: Associate Clinical Professor
          Role: Medical Student
          Role: Associate Professor
          Role: Professor, In Residence
          Journal
          1310650
          530
          Anesth Analg
          Anesth. Analg.
          Anesthesia and analgesia
          0003-2999
          1526-7598
          11 January 2017
          April 2017
          01 April 2018
          : 124
          : 4
          : 1298-1303
          Affiliations
          [1 ]Department of Anesthesiology, University of California San Diego
          [2 ]Department of Anesthesiology, University of California San Diego
          [3 ]Department of Anesthesiology, University of California San Diego
          [4 ]Department of Anesthesiology, University of California San Diego
          [5 ]Department of Anesthesiology, University of California San Diego
          [6 ]Department of Anesthesiology, University of California San Diego
          [7 ]School of Medicine, University of California San Diego
          [8 ]Department of Neurology, Keck School of Medicine, University of Southern California
          [9 ]Department of Anesthesiology, University of California San Diego and the OUTCOMES RESEARCH Consortium
          Author notes
          Address for correspondence: Brian M. Ilfeld, MD, MS, Department of Anesthesiology, 200 West Arbor Drive, MC 8770, San Diego, California, 92103-8770. Telephone: (858) 657-7030; Fax: (858) 683-2003; bilfeld@ 123456ucsd.edu
          Article
          PMC5362121 PMC5362121 5362121 nihpa841764
          10.1213/ANE.0000000000001939
          5362121
          28319550
          Categories
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