title: The effects of adding epinephrine to ropivacaine for popliteal nerve block on the duration of postoperative analgesia: a randomized controlled trial.
abstract: BACKGROUND
  Duration of peripheral nerve blocks depends on multiple factors. Both technique and type of local anesthetic used, either with or without adjuncts, may result in different duration times of the block. The purpose of the present study was to compare the duration of postoperative analgesia of 30 mL ropivacaine 0.75 % with or without epinephrine for popliteal sciatic nerve block.
  
  
  METHODS
  Thirty-eight patients were included to receive ultrasound guided continuous popliteal nerve block with ropivacaine 0.75 % either without (ROPI) or with epinephrine 5 μg/mL (ROPI-EPI) for ankle fusion, subtalar fusion, or a combination of both. The primary outcome parameter was the duration of postoperative analgesia as reflected by the time to first request for postoperative analgesia (TTFR) through the popliteal nerve catheter. Secondary outcome measures included the onset of sensory and motor block and NRS score for pain at rest and during movement.
  
  
  RESULTS
  Thirty patients, 15 in each group, were studied. Eight patients were withdrawn because of specific withdrawal criteria described in the protocol and replaced according to their group allocation. Median [interquartile range] TTFR was 463 [300-1197] min and 830 [397-1128] min for the ROPI vs ROPI-EPI group respectively. Hodges Lehman median difference between groups was 71 min (95 % CI -415 - 473 min). There was no difference in any clinical outcome measure between the groups.
  
  
  CONCLUSIONS
  The results of this study did not show any significant increase in the duration of postoperative analgesia by adding epinephrine to ropivacaine for popliteal nerve block. This may be due to the intrinsic vasoconstrictive properties of ropivacaine. The absence of a significant difference can also be the result of a type II error caused by a large variation in the individual TTFR.
  
  
  BACKGROUND
  Trial register.nl identifier: NTR3330 , keyword TTFR.
authors.affiliation: Department of Anaesthesiology, Post box 9011, 6500 GM, Nijmegen, The Netherlands. k.schoenmakers@maartenskliniek.nl.|Department of Anaesthesiology, Radboud University Medical Center, Nijmegen, The Netherlands. k.schoenmakers@maartenskliniek.nl.
authors.forename: Karin P W
authors.initials: KP
authors.lastname: Schoenmakers
authors.affiliation: Department of Anaesthesiology, Post box 9011, 6500 GM, Nijmegen, The Netherlands. m.fenten@maartenskliniek.nl.
authors.forename: Maaike G E
authors.initials: MG
authors.lastname: Fenten
authors.affiliation: Orthopaedic Surgery Sint Maartenskliniek, Post box 9011, 6500 GM, Nijmegen, The Netherlands. j.louwerens@maartenskliniek.nl.
authors.forename: Jan Willem
authors.initials: JW
authors.lastname: Louwerens
authors.affiliation: Department of Anaesthesiology, Radboud University Medical Center, Nijmegen, The Netherlands. gertjan.scheffer@radboudumc.nl.
authors.forename: Gert Jan
authors.initials: GJ
authors.lastname: Scheffer
authors.affiliation: Department of Anaesthesiology, Post box 9011, 6500 GM, Nijmegen, The Netherlands. r.stienstra@maartenskliniek.nl.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Stienstra
mesh_terms: D000368:Aged; D000577:Amides / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage; D004311:Double-Blind Method; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies; D000077212:Ropivacaine; D012584:Sciatic Nerve / Q000000981:diagnostic imaging; D013997:Time Factors; D018084:Ultrasonography, Interventional; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D000077212:Ropivacaine; D004837:Epinephrine