BILATERAL CONTINUOUS 3-IN-1 NERVE BLOCKADE FOR POSTOPERATIVE PAIN RELIEF AFTER BILATERAL FEMORAL-SHAFT SURGERY

We tested the effectiveness of bilateral continuous paravascular femor al nerve blocks in a patient following bilateral femoral shaft surgery in whom other analgesic regimens were considered contraindicated or o f limited effectiveness.Bilateral continuous femoral paravascular nerv e blocks were performed using a previously described technique. Genera l anesthesia was subsequently used to facilitate surgery, which was a bilateral osteosynthesis using dynamic hip screws for osteolytic metas tases of the proximal extremities of both femurs. A continuous infusio n of lidocaine, morphine, and clonidine was established in both femora l catheters preoperatively and used postoperatively as the principle s ource of analgesia. Radiographic contrast was used to document the pos ition of both catheters and to document the spread of injectate. Visua l analog scale (VAS) pain scores were recorded in the recovery room an d at 4, 16: 24, 48, and 72 hours postoperatively. Plasma lidocaine lev els were determined by gas chromatography at 4, 16, and 48 hours posto peratively. Sensory assessment in the distribution of the femoral, lat eral cutaneous, and obturator nerves was performed to confirm the pres ence of sensory blockade. We successfully provided analgesia with bila teral continuous femoral paravascular nerve blocks. Pain scores at res t were consistently rated good to excellent (VAS < 20 mm), Evidence of sensory conduction block was present throughout the infusion. Plasma concentrations of lidocaine were consistently below toxic levels (1.35 to 1.55 mu g/ml). Radiographic contrast studies failed to demonstrate movement of contrast to the level of the lumbar plexus. Bilateral con tinuous femoral paravascular nerve blocks can be used to provide effec tive and safe analgesia in patients requiring aggressive analgesia in whom other techniques may be contraindicated. (C) 1998 by Elsevier Sci ence Inc.