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Perineural dexamethasone with subsartorial saphenous nerve blocks in ACL reconstruction

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Subsartorial saphenous nerve blockade (SSNB) is an effective analgesic alternative to femoral nerve blockade after anterior cruciate ligament (ACL) reconstruction with bone-tendon-bone (BTB) autograft. It was hypothesized that dexamethasone in a SSNB will prolong analgesia, improve pain and satisfaction, and reduce postoperative opioid requirements and side effects.

Methods

One hundred ninety-five patients undergoing ACL reconstruction with BTB autograft (ages 16–65) were enrolled. Subjects received SSNB with 13 ml of 0.5 % bupivacaine (control group), 1 mg preservative-free dexamethasone +0.5 % bupivacaine (treatment group I), or 4 mg preservative-free dexamethasone +0.5 % bupivacaine (treatment group II). Subjects received identical perioperative management. On postoperative days 1 and 2, subjects reported perceived block duration, pain scores, satisfaction, opioid use, and side effects. Cox-proportional hazards modelling was used to compare block duration, adjusting for body mass index, age, sex, tourniquet time, American Society of Anesthesiologists classification, and intravenous dexamethasone dose.

Results

Patient-perceived block duration was significantly increased in treatment group I [hazard ratio (95 % confidence interval [CI]) 0.48 (0.31–0.75); P = 0.001] and treatment group II (hazard ratio (95 % CI): 0.52 (0.33–0.81); P = 0.004) compared to control. The block was extended from a median (95 % CI) of 33.1 (28.4–37.3) to 41.2 (32.4–50.9) and 46.5 (35.8–48.9) hours, respectively. Additionally, patients in treatment group II reported increased time that block provided pain relief, higher patient satisfaction, lower pain scores at rest, and decreased drowsiness and confusion.

Conclusion

The addition of 1 and 4 mg of dexamethasone to the block injectate significantly increased SSNB duration by 8–13 h compared to control.

Level of evidence

Therapeutic study, level 1.

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Acknowledgments

This study was funded by the Research and Education Fund of the Department of Anesthesiology at the Hospital for Special Surgery. The use of REDCap was funded by the National Institutes of Health (#UL1TR000457).

Funding

Department of Anesthesiology, Hospital for Special Surgery (study) and National Institutes of Health: Clinical and Translational Science Center Grant UL-1RR024996 (REDCAP; data collection).

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Hospital for Special Surgery, New York, NY, USA

    Mary F. Chisholm, Jennifer Cheng, Daniel B. Maalouf, Gregory A. Liguori, Michael A. Gordon, Victor M. Zayas & Jacques T. Yadeau

  2. Healthcare Research Institute, Hospital for Special Surgery, New York, NY, USA

    Kara G. Fields

  3. Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA

    Robert G. Marx

Authors
  1. Mary F. Chisholm
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  2. Jennifer Cheng
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  3. Kara G. Fields
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  4. Robert G. Marx
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  5. Daniel B. Maalouf
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  6. Gregory A. Liguori
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  7. Michael A. Gordon
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  8. Victor M. Zayas
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  9. Jacques T. Yadeau
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Corresponding author

Correspondence to Mary F. Chisholm.

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Conflict of interest

M. F. C., J. C., K. G. F., D. B. M., G. A. L., M. A. G., V. M. Z., and J. T. Y. declare that they have no conflict of interests. R. G. M. declares the following conflict of interests: employment on the Editorial Board of Journal of Bone and Joint Surgery and two books (“Revision ACL Reconstruction: Indications and Technique” [Springer, 2013] and “The ACL Solution” [Desmos Health, 2012]).

Additional information

IRB: this study was approved by the IRB at the Hospital for Special Surgery. Clinicaltrials.gov Registration Number: NCT #01586806.

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Chisholm, M.F., Cheng, J., Fields, K.G. et al. Perineural dexamethasone with subsartorial saphenous nerve blocks in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 25, 1298–1306 (2017). https://doi.org/10.1007/s00167-016-4120-3

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  • DOI: https://doi.org/10.1007/s00167-016-4120-3

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