Similar Analgesic Effect After Popliteal Fossa Nerve Blockade with 0.375% and 0.75% Bupivacaine

HSS Journal

David S. Levine, MD
David S. Levine, MD

Associate Attending Orthopaedic Surgeon, Hospital for Special Surgery
Associate Professor of Orthopaedic Surgery, Weill Cornell Medical College

Jacques T. Ya Deau, MD, PhD
Hospital for Special Surgery

Barbara U. Wukovits, RN, BSN, C
Hospital for Special Surgery

Vincent R. LaSala, MD
Hospital for Special Surgery

Kethy M. Jules-Elysée, MD
Hospital for Special Surgery

Leonardo Paroli, MD, PhD
Hospital for Special Surgery

Richard L. Kahn, MD
Hospital for Special Surgery

Jane Y. Lipnitsky, BA
Hospital for Special Surgery

This study tested the hypothesis that increasing the concentration of bupivacaine from 0.375% to 0.75% would increase the duration of postoperative analgesia by 3 hours.

Seventy patients scheduled for hospital admission after foot or ankle surgery gave consent to enter this prospective randomized trial.  Patients were randomly assigned to receive a popliteal fossa block (posterior approach) using 30 cc of either 0.375% or 0.75% bupivacaine, with epinephrine.  Patients also received a neuraxial anesthetic and postoperative intravenous patient-controlled analgesia.  Patient characteristics, duration of analgesia, pain scores, use of analgesic medications, and side effects of analgesic therapy were determined.

Duration of analgesia was similar with both concentrations of bupivacaine (0.375%: 14 ± 8 hr; 0.75%: 13 ± 6 hr, mean ± standard deviation).  Pain scores were the same for both groups on the first postoperative day (3 of 10 at rest, 5 with therapy).   Analgesic use and side effects attributable to pain management did not differ between groups.

In conclusion, postoperative analgesia was not affected by the concentration of bupivacaine used for the nerve block.  There was no benefit to increasing the concentration of bupivacaine above 0.375% for single-injection popliteal fossa nerve blockade when performed for postoperative analgesia.

This article appears in HSS Journal: Volume 3, Number 2.
View the full article at

About the HSS Journal
HSS Journal, an academic peer-reviewed journal, is published twice a year, February and September, and features articles by internal faculty and HSS alumni that present current research and clinical work in the field of musculoskeletal medicine performed at HSS, including research articles, surgical procedures, and case reports.


Related Conditions

Back in the Game Patient Stories: