Lidocaine Versus Bupivacaine in Ambulatory Continuous Block With Elastomeric Pump
Condition: Hallux Valgus
MeSH terms: Hallux Valgus
Study type: Interventional
Phase: Phase 4

Summary: 
      In practice ambulatory orthopedic surgery, one of the problems of most difficult solution is
      adequate control of postoperative analgesia. Pain is a frequent cause of consultation and
      unscheduled readmissions in this group of patients.

      The use of continuous peripheral nerve blocks are an effective tool in postoperative
      analgesia.

      In this connection, most of the studies of continuous infusions of local anesthetics by
      perineural catheters have been made with bupivacaine, levobupivacaine, and ropivacaine
      However, it has been found that lidocaine action lasts less, has lower cost and is less toxic
      than longer-acting agents.

      The investigators aim is to compare the effectiveness of lidocaine versus bupivacaine
      continuous popliteal sciatic blockade ambulatory elastomeric pump.
    

Detailed description: 
      In the practice of orthopedic outpatient surgery, one of the most intractable problems is
      proper control of post-operative analgesia . Pain is a frequent cause of consultations and
      unscheduled readmissions in this group of patients.

      The use of continuous peripheral nerve blocks are an effective tool in postoperative
      analgesia , allowing prolong the effect of the blockade by the time you want. Such techniques
      have been described by different groups for the management of postoperative pain with good
      results even successfully used in ambulatory practice .

      However, sending patients home with a continuous infusion pump to local anesthetics causes
      some problems , such as the method of administration , cost and risk of poisoning by these
      drugs.

      With regard to the method of administration , have been used electronic continuous infusion
      pumps even allow boluses of demand , with good results. However, its use implies a higher
      cost and are more difficult to use by patients.

      An alternative of greater simplicity and lower cost is the use of disposable pumps (
      elastomeric pumps ) without electronic components , which through a simple mechanism to allow
      a predetermined continuous infusion flow . It has been seen that the use of elastomeric pumps
      for continuous peripheral nerve blocks are associated with fewer technical problems and more
      satisfied patients electronic pumps .

      Another problem that occurs with the use of ambulatory continuous technical risk is secondary
      to the administration of local anesthetic solutions long-acting toxicity in a home
      environment , without immediate medical intervention. While this is a potential risk of
      toxicity , this problem could be avoided by using less toxic drugs .

      In this connection , most of the studies of continuous infusion of local anesthetics by
      perineural catheters have been made with bupivacaine , levobupivacaine , and ropivacaine .
      However, it has been found that lidocaine lasts less action , has a lower cost and is less
      toxic than the long-acting agents , although no studies which continuous infusion of
      lidocaine home . In addition , there is evidence of comparable effectiveness between
      solutions of bupivacaine and lidocaine in continuous epidural infusion for postoperative
      analgesia , why lidocaine is likely to be a good alternative for continuous ambulatory blocks
      .

      Therefore, the investigators objective is to compare the effectiveness of lidocaine versus
      bupivacaine in ambulatory popliteal sciatic blockade with continuous elastomeric pump .
    

Intervention name(s): Lidocaine; Bupivacaine
Intervention type(s): Drug; Drug
Intervention description(s): Continuous block with lidocaine in both legs. Lidocaine infusion starts 0.5% to 5 ml hour Baxter Infusor elastomeric pump LV 5 ml / hr; Continuous block with lidocaine in both legs. Infusion starts bupivacaine 0.1% to 5 ml hour Baxter Infusor elastomeric pump LV 5 ml / hr
Other intervention name(s): Marcaine
Intervention MeSH terms: Lidocaine; Bupivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Peripheral nerve block; Lidocaine; Bupivacaine