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HSS Journal ®

, Volume 10, Issue 3, pp 245–251 | Cite as

Postoperative Analgesia with Saphenous Block Appears Equivalent to Femoral Nerve Block in ACL Reconstruction

  • Mary F. ChisholmEmail author
  • Heejung Bang
  • Daniel B. Maalouf
  • Dorothy Marcello
  • Marco A. Lotano
  • Robert G. Marx
  • Gregory A. Liguori
  • Victor M. Zayas
  • Michael A. Gordon
  • Jason Jacobs
  • Jacques T. YaDeau
Original Article

Abstract

Background

Adequate pain control following anterior cruciate ligament reconstruction (ACL) often requires regional nerve block. The femoral nerve block (FNB) has been traditionally employed. Ultrasound application to regional nerve blocks allows for the use of alternatives such as the saphenous nerve block following ACL reconstruction.

Questions/Purposes

This study evaluated postoperative analgesia provided by the subsartorial saphenous nerve block (SSNB) compared to that provided by the traditional FNB for patients undergoing ACL reconstruction with patellar tendon (bone–tendon–bone (BTB)) autografts.

Methods

A randomized, blinded, controlled clinical trial was conducted using 80 ASA I–III patients, ages 16–65, undergoing ACL reconstruction with BTB. The individuals assessing all outcome measures were blinded to the treatment group. Postoperatively, all patients received cryotherapy and parenteral hydromorphone to achieve numeric rating scale pain scores less than 4. At discharge, patients were given prescriptions for oral opioid analgesics and a scheduled NSAID. Patients were instructed to complete pain diaries and record oral opioid utilization. Patients were contacted on postoperative days (POD) 1 and 2 to ascertain the level of patient satisfaction with the analgesic regimen.

Results

No differences between the two groups were found. Patient demographics and postoperative pain scores at rest were not different. In addition, there was no difference in opioid use, as measured in daily oral morphine equivalents between groups. A small but statistically significant report of higher patient satisfaction with the FNB was found on POD 1 but not on POD 2.

Conclusion

These data support our hypothesis that the SSNB provides similar and adequate postoperative analgesia when compared to the FNB, following arthroscopic ACL reconstruction with patellar tendon autograft.

Keywords

postoperative analgesia ACL reconstruction saphenous nerve block femoral nerve block pain 

Notes

Disclosures

Conflict of Interest:

Mary F. Chisholm, MD, Heejung Bang, PhD, Daniel B. Maalouf, MD, MPH, Dorothy Marcello, BA, Marco A. Lotano, MD, Robert G. Marx, MD, MSc, FRCSC, Gregory A. Liguori, MD, Victor M. Zayas, MD, Michael A. Gordon, MD and Jason Jacobs and Jacques T. YaDeau, MD, PhD have declared that they have no conflict of interest.

Human/Animal Rights:

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

Informed Consent:

Informed consent was obtained from all patients for being included in the study.

Required Author Forms

Disclosure forms provided by the authors are available with the online version of this article.

Supplementary material

11420_2014_9392_MOESM1_ESM.pdf (1.2 mb)
ESM 1 (PDF 1.19 MB)
11420_2014_9392_MOESM2_ESM.doc (75 kb)
ESM 2 (DOC 75 kb)

References

  1. 1.
    Apfelbaum JL, Gan TJ, Zhao S, Hanna DB, Chen C. Reliability and validity of the perioperative opioid-related symptom distress scale. Anesthesia and Analgesia. 2004; 99: 699-709.PubMedCrossRefGoogle Scholar
  2. 2.
    Brown DW, Curry CM, Ruterbories LM, Avery FL, Anson PS. Evaluation of pain after arthroscopically assisted anterior cruciate ligament reconstruction. American Journal of Sports Medicine. 1997; 25(2): 182-186.PubMedCrossRefGoogle Scholar
  3. 3.
    Brull R, McCartney CJ, Chan VW, El-Beheiry H. Neurological complications after regional anesthesia. Contemporary estimates of risk. Anesthesia and Analgesia. 2007; 104(4): 965-974.PubMedCrossRefGoogle Scholar
  4. 4.
    Cabor DN, Johnson BM. The natural history of the anterior cruciate ligament-deficient knee. A review. Clinics in Sports Medicine. 2008; 27: 405-424.CrossRefGoogle Scholar
  5. 5.
    Dauri M, Fabbi E, Mariani P, Faria S, Carpenedo R, et al. Continuous femoral nerve block provides superior analgesia compared with continuous intra-articular and wound infusion after anterior cruciate ligament reconstruction. Regional Anesthesia and Pain Medicine. 2009; 34(2): 95-9.PubMedCrossRefGoogle Scholar
  6. 6.
    de Lima E, Souza R, Correa CH, et al. Single-injection femoral nerve block with 0.25% ropivacaine or 0.25% bupivacaine for postoperative analgesia after total knee replacement or anterior cruciate ligament reconstruction. Journal of Clinical Anesthesia. 2008; 20(7): 521-7.CrossRefGoogle Scholar
  7. 7.
    Diggle PJ, Heagerty P, Liang KY, Zeger S. The analysis of longitudinal data. 2nd ed. Oxford: Oxford Univ Press; 2002.Google Scholar
  8. 8.
    Edkin BS, McCarty EC, Spindler KP, Flanagan JF. Analgesia with femoral nerve block for anterior cruciate ligament reconstruction. Clinical Orthopaedics and Related Research. 1999; 369: 289-95.PubMedCrossRefGoogle Scholar
  9. 9.
    Gordon DB, Stevenson KK, Griffie J, Muchka S, Rapp C, et al. Opioid equianalgesic calculations. Journal of Palliative Medicine. 1999; 2: 209-19.PubMedCrossRefGoogle Scholar
  10. 10.
    Iskandar H, Benard A, Ruel-Raymond J, Cochard G, Manaud B. Femoral block provides superior analgesia compared with intra-articular ropivacaine after anterior cruciate ligament reconstruction. Regional Anesthesia and Pain Medicine. 2003; 28(1): 29-32.PubMedCrossRefGoogle Scholar
  11. 11.
    Krombach J, Gray AT. Sonography for saphenous nerve block near the adductor canal. Regional Anesthesia and Pain Medicine. 2007; 32(4): 369-70.PubMedCrossRefGoogle Scholar
  12. 12.
    Lundblad M, Karpal S, Marhofer P, Lonnqvist PA. Ultrasound-guided infrapatellar nerve block in human volunteers: description of a novel technique. BJA: British Journal of Anaesthesia. 2006; 97(5): 710-14.PubMedCrossRefGoogle Scholar
  13. 13.
    Mulroy MF, Larkin KL, Batra MS, Hodgson PS, Owens BD. Femoral nerve block with 0.25% or 0.5% bupivacaine improves postoperative analgesia following outpatient arthroscopic anterior cruciate ligament repair. Regional Anesthesia and Pain Medicine. 2001; 26: 24-29.PubMedCrossRefGoogle Scholar
  14. 14.
    Palmieri-Smith RM, Thomas AC, Wojtys EM. Maximizing quadriceps strength after ACL reconstruction. Clinics in Sports Medicine. 2008; 27: 405-424.PubMedCrossRefGoogle Scholar
  15. 15.
    Peng P, Claxton A, Chung F, Chan V, Miniaci A, Krishnathas A. Femoral nerve block and ketorolac in patients undergoing anterior cruciate ligament reconstruction. Canadian Journal of Anesthesia. 1999; 46(10): 919-24.PubMedCrossRefGoogle Scholar
  16. 16.
    Standl T, Eckert S, Shulteam Esch J. Postoperative complaints after spinal and thiopentone-isoflurane anaesthesia in patients undergoing orthopaedic surgery. Spinal versus general anaesthesia. Acta Anaesthesiologica Scandinavica. 1996; 40(2): 222-6.PubMedCrossRefGoogle Scholar
  17. 17.
    Van der Wal M, Lang SA, Yip RW. Transsartorial approach for saphenous nerve block. Canadian Journal of Anaesthesia. 1993; 40(6): 542-6.PubMedCrossRefGoogle Scholar
  18. 18.
    Williams BA, Kentor ML, Bottegal MT. The incidence of falls at home in patients with perineural femoral catheters: A retrospective summary of a randomized clinical trial. Anesthesia and Analgesia. 2009; 104(4): 1002.CrossRefGoogle Scholar

Copyright information

© Hospital for Special Surgery 2014

Authors and Affiliations

  • Mary F. Chisholm
    • 1
    Email author
  • Heejung Bang
    • 2
    • 4
  • Daniel B. Maalouf
    • 1
  • Dorothy Marcello
    • 1
  • Marco A. Lotano
    • 1
  • Robert G. Marx
    • 3
  • Gregory A. Liguori
    • 1
  • Victor M. Zayas
    • 1
  • Michael A. Gordon
    • 1
  • Jason Jacobs
    • 1
  • Jacques T. YaDeau
    • 1
  1. 1.Department of AnesthesiologyHospital for Special SurgeryNew YorkUSA
  2. 2.Department of Statistical ScienceWeill Cornell Medical CollegeNew YorkUSA
  3. 3.Department of Orthopedic SurgeryHospital for Special SurgeryNew YorkUSA
  4. 4.UC DavisDavisUSA

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