Abstract
Purpose
Three studies were conducted to determine whether and how the obturator nerve bears relevance to intra- and postoperative pain in patients undergoing anterior cruciate ligament (ACL) reconstruction using a hamstring autograft.
Methods
Patients undergoing arthroscopic ACL reconstruction using a hamstring autograft were enrolled in three studies. In the first study, we studied the analgesic effect of combined posterior lumbar plexus (PLP) and sciatic nerve blocks as well as combined femoral, lateral femoral cutaneous, and sciatic nerve blocks during and for 24 h after surgery. The second study was conducted to compare the analgesic effect of the combination of femoral, lateral femoral cutaneous, and sciatic nerve blocks with and without an obturator nerve block. Finally, we compared a postoperative continuous femoral nerve block and PLP block both during and for 48 h after surgery.
Results
In the first study, patients receiving the PLP block required significantly less fentanyl intraoperatively than those given the femoral nerve block. In the second, significantly less fentanyl was required during surgery for patients with the obturator nerve block than for those without. Finally, the continuous postoperative PLP block showed higher visual analog pain scores than those with the continuous femoral nerve block during movement at 48 h.
Conclusion
The present results suggest the involvement of the obturator nerve in ACL reconstruction using a hamstring autograft. However, although obturator nerve blockade is crucial for intraoperative analgesia, a continuous obturator nerve block is not necessary beyond 24 h postoperatively.
Similar content being viewed by others
References
Ota J, Sakura S, Hara K, Yoji S. Ultrasound-guided anterior approach to sciatic nerve block: a comparison with the posterior approach. Anesth Analg. 2009;108:660–5.
Gray AT, Collins AB, Schafhalter-Zoppoth I. An introduction to femoral nerve and associated lumbar plexus nerve blocks under ultrasonic guidance. Tech Reg Anesth Pain Manag. 2004;8:155–63.
Hara K, Sakura S, Nomura T, Ota J, Tadenuma S. Ultrasound guided lateral femoral cutaneous nerve: an evaluation of a sub-inguinal ligament approach. Eur J Anaesth. 2008;25:8AP2–6.
Sakura S, Hara K, Horn JL. Ultrasound-guided lumbar plexus block (transverse approach). In: Bigeleisen PE, editor. Ultrasound-guided regional anesthesia and pain medicine. Philadelphia: Lippincott Williams & Wilkins; 2009. p. 81–8.
Doi K, Sakura S, Hara K. A modified posterior approach to lumbar plexus block using a transverse image and an approach from the lateral border of the transducer. Anaesth Intensive Care. 2010;38:213–4.
Sinha SK, Abrams JH, Houle TT, Weller RS. Ultrasound-guided obturator nerve block: an interfascial injection approach without nerve stimulation. Reg Anesth Pain Med. 2009;34:261–4.
Capdevila X, Macaire P, Dadure C, Choquet O, Biboulet P, Ryckwaert Y, d’Athis F. Continuous psoas compartment block for postoperative analgesia after total hip arthroplasty: new landmarks, technical guidelines, and clinical evaluation. Anesth Analg. 2002;94:1606–13.
Kaloul I, Guay J, Cote C, Fallaha M. The posterior lumbar plexus (psoas compartment) block and the three-in-one femoral nerve block provide similar postoperative analgesia after total knee replacement. Can J Anesth. 2004;51:45–51.
Robards CB, Hadzic A. Lumbar plexus block. In: Hadzic A, editor. Textbook of regional anesthesia and acute pain management. New York: McGraw-Hill Medical; 2007. p. 481–8.
Ozalp G, Kaya M, Tuncel G, Canoler O, Gulnerman G, Savli S. The analgesic efficacy of two different approaches to the lumbar plexus for patient-controlled analgesia after total knee replacement. J Anesth. 2007;21:409–12.
McNamee DA, Parks L, Milligan KR. Post-operative analgesia following total knee replacement: an evaluation of the addition of an obturator nerve block to combined femoral sciatic nerve block. Acta Anaesthesiol Scand. 2002;46:95–9.
Macalou D, Trueck S, Meuret P, Heck M, Vial F, Ouologuem S, Capdevila X, Virion JM, Bouaziz H. Postoperative analgesia after total knee replacement: the effect of an obturator nerve block added to the femoral 3-in-1 nerve block. Anesth Analg. 2004;99:251–4.
Gray AT. Ultrasound-guided regional anesthesia: current state of the art. Anesthesiology. 2006;104:368–73.
Marhofer P, Chan VWS. Ultrasound-guided regional anesthesia: current concepts and future trends. Anesth Analg. 2007;104:1265–9.
Marhofer P, Greher M, Kapral S. Ultrasound guidance in regional anaesthesia. Br J Anaesth. 2005;94:7–17.
Sites BD, Brull R, Chan VWS, Spence BC, Gallagher JD, Beach ML, Sites VR, Abbas S, Harman GS. Artifacts and pitfall errors associated with ultrasound-guided regional anesthesia. Part I: understanding the basic principles of ultrasound physics and machine operations. Reg Anesth Pain Med. 2007;32:412–8.
Marhofer P. Ultrasound guidance for nerve blocks: principles and practical implementation. Oxford: Oxford University Press; 2008.
Acknowledgments
Funding and study equipment support were provided by departmental and institutional sources and SonoSite Japan. KK (Tokyo, Japan).
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Sakura, S., Hara, K., Ota, J. et al. Ultrasound-guided peripheral nerve blocks for anterior cruciate ligament reconstruction: effect of obturator nerve block during and after surgery. J Anesth 24, 411–417 (2010). https://doi.org/10.1007/s00540-010-0916-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00540-010-0916-3