Intermittent bolus versus continuous infusion popliteal sciatic nerve block following major foot and ankle surgery: a prospective randomized comparison
Bibliographic record
Abstract
BACKGROUND AND OBJECTIVES: Foot and ankle surgery is associated with severe pain that can be reduced with continuous popliteal sciatic nerve block. We tested the hypothesis that programmed intermittent bolus (PIB) delivery of local anesthetic provides superior analgesia to a continuous infusion (CI) regimen. METHODS: 60 patients undergoing major foot and ankle surgery were randomized to receive PIB (10 mL of ropivacaine 0.2% every 2 hours) or CI (5 mL/hour) continuous popliteal sciatic nerve block with patient-controlled regional analgesia (5 mL every 30 min as needed) provided for all. Primary outcome was the average of static and dynamic numerical rating scale (NRS) pain scores through 48 hours. Secondary outcomes included rest and movement NRS pain scores at different timepoints, opioid consumption, local anesthetic consumption, intensity of sensory and motor block, patient satisfaction and the incidence of opioid-related side effects. RESULTS: There was no significant difference in the primary outcome of average NRS pain score through 48 hours, opioid consumption or the volume of local anesthetic administered. Patients in group PIB had significantly decreased strength of toe dorsiflexion at 6 hours (p=0.007) and 12 hours (p=0.001) and toe plantarflexion at 12 hours (p=0.004). Patient satisfaction and the incidence of side effects was similar between groups. CONCLUSIONS: Both CI and PIB regimens provided excellent analgesia, low opioid consumption and high patient satisfaction. While there was no difference in analgesic outcomes, PIB dosing resulted in a more profound motor block. TRIAL REGISTRATION NUMBER: NCT02707874.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".