First Author, Year |
Surgical Procedure |
Treatment Group |
Control Group(s) During Catheter Utilization |
Primary Positive Findings During Catheter Use (Treatment Group Superior Unless Otherwise Noted) |
Interscalene catheters |
Fredrickson et al163 (2010) |
Minor arthroscopic shoulder |
Ropivacaine 0.2% (n = 31) 2 mL/h + 5 mL PCB [60] |
Catheters removed in recovery room (n = 30) |
Lower resting and dynamic pain scores; less supplemental analgesic requirements |
Malhotra et al20 (2013) |
Adhesive capsulitis manipulation |
Ropivacaine 0.2% (n = 2) 8 mL/h + 4 mL PCB [30] |
Normal saline (n = 2) 8 mL/h + 4 mL PCB [30] |
Lower average and dynamic pain scores; lower opioid analgesics; fewer awakenings because of pain; greater shoulder range of motion on day 1 as well as weeks 6 and 12 (preliminary data from a pilot study—underpowered for definitive conclusions) |
Salviz et al176 (2013) |
Arthroscopic rotator cuff repair |
Ropivacaine 0.2% (n = 20) 5 mL/h + 5 mL PCB [60] |
•Single injection only (n = 23) •No block or catheter (n = 20) |
Catheter group with less pain, opioid requirements, and sleep disturbances; at 7 d (2-d infusion) only 26% of catheter group reported NRS ≥4 compared with 83% and 58% of single-injection and no block groups, respectively |
Infraclavicular catheters |
Eng et al173 (2015) |
Complex arthroscopic elbow |
Ropivacaine 0.2% 7 mL/h + 5 mL PCB [30] |
Total hospital cost of care was 15% lower in the early discharge group; no other differences between treatment groups including elbow range of motion |
Discharge as early as postoperative day 1 (n = 19) |
Required to remain hospitalized 72 h (n = 19) |
Paravertebral catheters |
Ilfeld et al167,177 (2014) and (2015) |
Mastectomy |
Ropivacaine 0.4% (n = 30) 5 mL/h basal only |
Normal saline (n = 30) 5 mL/h basal only |
Lower resting and breakthrough pain scores; less pain-induced physical and emotional dysfunction during infusion; less chronic pain at 1 y |
Karmakar et al221 (2014) |
Modified radical mastectomy |
Ropivacaine 0.25% (n = 60) 0.1 mL/kg/h basal only |
•Single injection only (n = 57) •No block or catheter (n = 60) |
No differences among groups during infusion period nor chronic pain incidence at 3 or 6 mo, but at 3 and 6 mo, both infusion and single-injection group had less severe pain, exhibited fewer symptoms and signs of chronic pain, and experienced better physical and mental health-related quality of life |
Pintaric et al204 (2011) |
Thoracotomy (open lung surgery) |
Levobupivacaine 0.125% and morphine 30 μg/mL (n = 16) 0.1 mL/kg/h + 0.1 mL/kg PCB [60] |
Epidural levobupivacaine and morphine at same concentration and rate/bolus as paravertebral catheters |
Similar analgesia but greater hemodynamic stability than epidural analgesia with less required colloid volume and vasopressors to maintain target oxygen delivery index |
Transversus abdominis plane (TAP) catheters |
Heil et al33 (2014) |
Abdominal or inguinal hernia repair |
Ropivacaine 0.2% (n = 10) 10 mL/h basal only |
Normal saline (n = 10) 10 mL/h basal only |
No statistically significant difference in pain scores or supplemental analgesics (underpowered study because of curtailment of enrollment) |
Niraj et al36 (2011) |
Open renal or hepatobiliary |
Bupivacaine 0.375% (n = 29) 1 mg/kg each of bilateral catheters every 8 h |
Epidural bupivacaine 0.125% with fentanyl 2 μg/mL (n = 33) 6–12 mL/h + 2 mL PCB [30] |
No statistically significant differences in any outcomes between treatments except that the TAP group required a higher dose of rescue analgesics |
Adductor canal catheters (placebo controlled) |
Andersen et al64 (2013) |
Total knee arthroplasty |
Ropivacaine 0.75% (n = 20) 15 mL "twice daily" |
Normal saline (n = 20) 15 mL "twice daily" |
Lower average resting and breakthrough (maximum) pain scores and fewer sleep disturbances; ambulation possible in 100% vs 65% of subjects in the ropivacaine vs saline groups, respectively |
Grevstad et al65 (2015) |
Severe pain on flexion after total knee arthroplasty |
Ropivacaine 0.75% (n = 24) 30 mL single injection |
Normal saline (n = 25) 30 mL single injection |
Reduced pain during active flexion of the knee, but a large proportion (78%) still had at least moderate pain on flexion |
Hanson et al61 (2014) |
Total knee arthroplasty |
Ropivacaine 0.2% (n = 36) 8 mL/h basal only |
Sham catheter (n = 40) |
Decreased resting and dynamic pain scores, lower required supplemental analgesics, greater quadriceps strength, greater ambulation distance, and higher satisfaction |
Jaeger et al47 (2012) |
Total knee arthroplasty |
Ropivacaine 0.75% (n = 21) 30 mL single injection |
Normal saline (n = 20) 30 mL single injection |
Decreased pain during hours 1–6 and less nausea |
Jæger et al63 (2014) |
Revision total knee arthroplasty |
Ropivacaine 0.75% (n = 14) 30 mL bolus; 6 h later 0.2% 15 mL bolus; then ropivacaine 0.2% 8 mL/h |
Normal saline (n = 13) administered at the same time points and volumes as the ropivacaine group |
Lower pain on knee flexion at 4 h (underpowered study for remainder of endpoints) |
Jenstrup et al62 (2012) |
Total knee arthroplasty |
Ropivacaine 0.75% (n = 34) 30 mL bolus; then 15 mL bolus at 6, 12, 18, and 24 h |
Normal saline (n = 37) administered at the same time points and volumes as the ropivacaine group |
Lower dynamic pain on flexion and supplemental analgesic requirements, superior ambulation, and mobilization at 24 h |
Fisker et al459 (2015) |
Major ankle surgery |
Continuous popliteal sciatic blocks for all subjects |
No differences between treatment groups detected |
Ropivacaine 0.2% (n = 20) 5 mL/h basal only |
Normal saline (n = 24) 5 mL/h basal only |
Adductor canal catheters (versus femoral catheters) |
Elkassabany et al59 (2016) |
Total knee arthroplasty |
Adductor ropivacaine 0.2% (n = 31) 8 mL/h basal only |
Femoral ropivacaine 0.2% (n = 31) 8 mL/h basal only |
Greater quadriceps femoris strengtha |
Jæger et al50 (2013) |
Total knee arthroplasty |
Adductor ropivacaine 0.2% (n = 22) 8 mL/h basal only |
Femoral ropivacaine 0.2% (n = 26) 8 mL/h basal only |
Greater quadriceps femoris strength (52% vs 18% of baseline) |
Machi et al58 (2015) |
Total knee arthroplasty |
Adductor ropivacaine 0.2% (n = 39) 6–8 mL/h + 4 mL PCB [30] |
Femoral ropivacaine 0.2% (n = 39) 4–8 mL/h + 4 mL PCB [30] |
Improved ability to stand, sit, and ambulate, but higher dynamic pain scores than femoral infusion |
Shah and Jain74 (2014) |
Total knee arthroplasty |
Adductor ropivacaine 0.75% (n = 48) 30 mL, then ropivacaine 0.25% 30 mL every 4 h until postoperative day 2 |
Femoral ropivacaine 0.75% (n = 50) 30 mL, then ropivacaine 0.25% 30 mL every 4 h until postoperative day 2 |
Improved ability to stand, sit, and ambulate, as well as climb stairs; decreased time until actual discharge (3.1 vs 3.9 d) |
Sztain et al57 (2015) |
Unicompartment knee arthroplasty |
Adductor ropivacaine 0.2% (n = 15) 6–8 mL/h + 4 mL PCB [30] |
Femoral ropivacaine 0.2% (n = 15) 2–6 mL/h + 4 mL PCB [30] |
Fewer days until discharge readiness; improved ability to sit, stand, and ambulate; but higher resting pain scores than femoral infusion |
Zhang et al209 (2014) |
Total knee arthroplasty |
Adductor ropivacaine 0.2% (n = xx) 5 mL/h + 5 mL PCB [30] |
Femoral ropivacaine 0.2% (n = x) 5 mL/h + 5 mL PCB [30] |
Greater quadriceps femoris strength (52% vs 18% of baseline) |
Femoral catheters |
Al-Zahrani et al447 (2015) |
Total knee arthroplasty |
Femoral bupivacaine 0.2% (n = 25) 5 mL/h basal only (singleinjection sciatic block 15 mL bupivacaine 0.25%) |
Epidural bupivacaine 0.0625% + fentanyl 2 μg/mL (n = 25) 5–10 mL/h basal only |
No differences between treatment groups detected |
Sakai et al198 (2013) |
Total knee arthroplasty |
Femoral ropivacaine 0.15% (n = 30) 4 mL/h basal only |
Epidural ropivacaine 0.15% (n = 30) 4 mL/h basal only |
Shorter time to achieve 120° knee flexion (8 vs 15 d), improved dynamic analgesia, and lower supplemental analgesic requirements |
Baranović et al196 (2011) |
Total knee arthroplasty |
Femoral levobupivacaine 0.25% (n = 35) 5–6 mL/h basal only |
No catheter (n = 36) |
Improved analgesia, improved knee flexion on postoperative day 2, lower intravenous morphine requirements, and dramatically lower opioid-related adverse events such as urinary retention, sedation, and nausea/vomiting |
Peng et al216 (2014) |
Total knee arthroplasty |
Femoral ropivacaine 0.15% (n = 127) 5 mL/h + 5 mL [30] |
No catheter (n = 123) |
Less supplemental analgesics required and improved knee flexion during infusion, and lower incidence of chronic pain and improved knee flexion at 3 and 6 mo after surgery |
Wu and Wong197 (2014) |
Total knee arthroplasty |
Femoral levobupivacaine 0.08% (n = 30) 8–12 mL/h basal only |
No catheter (n = 30) |
Lower intravenous opioid requirements, fewer opioid-related side effects, improved satisfaction with analgesia, and increased ambulation ability |
Sciatic catheters |
Elliot et al200 (2010) |
Hind foot or ankle surgery |
Bupivacaine 0.25% (n = 27) 4 mL/h + 1 mL [60] |
Normal saline (n = 27) 4 mL/h + 1 mL [60] |
Lower pain scores and less supplemental analgesic requirements |
Saporito et al194 (2014) |
Toes 2–5 osteotomy or hallux valgus correction |
Ropivacaine 0.2% 5 mL/h + 5 mL PCB [60] |
Total costs of care were 79% lower in the early discharge group; no other differences between treatment groups including pain scores, complications, and readmission rates |
Discharged day of surgery (n = 60) |
Required to remain hospitalized 2 nights (n = 60) |
Cappelleri et al96 (2011) |
Total knee arthroplasty |
Continuous posterior lumbar plexus blocks for all subjects |
Lower resting and dynamic pain scores, less supplemental opioids, lower incidence of nausea and vomiting, improved knee flexion and ambulation |
Subgluteal levobupivacaine 0.06% (n = 19) 0.1 mL/kg/h |
Subgluteal normal saline (n = 19) 0.1 mL/kg/h |
Sato et al201 (2014) |
Total knee arthroplasty |
Continuous femoral nerve blocks for all subjects |
Lower resting pain scores and less supplemental opioids |
Subgluteal ropivacaine 0.2% (n = 30) 5 mL/h |
Subgluteal normal saline (n = 30) 5 mL/h |
Wegener et al97,220 (2011) and (2013) |
Total knee arthroplasty |
Continuous femoral nerve blocks for all subjects |
Catheter group with lower dynamic pain scores compared with the other 2 treatment groups on postoperative days 1 and 2 during the infusion; and in a subset of the most initially disabled subjects preoperatively, joint stiffness was reduced at 3 and 12 mo, and dynamic pain reduced at 3 mo compared with the no block or catheter group |
Parasacral levobupivacaine 0.125% (n = 30) 10 mL/h |
•Parasacral single injection only (n = 30) •No block or catheter (n = 30) |
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