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

HSS Journal Online First Article

Mary F. Chisholm, MD

Assistant Attending Anesthesiologist, Hospital for Special Surgery
Assistant Clinical Professor in Anesthesiology, Weill Cornell Medical College

Heejung Bang, PhD

Department of Statistical Science, Weill Cornell Medical College

Daniel B. Maalouf, MD, MPH

Assistant Attending Anesthesiologist, Hospital for Special Surgery

Dorothy Marcello, BA

Department of Anesthesiology, Hospital for Special Surgery

Marco A. Lotano, MD

Department of Anesthesiology, Hospital for Special Surgery


Robert G. Marx, MD, MSc, FRCSC

Robert G. Marx, MD, MSc, FRCSC

Attending Orthopaedic Surgeon, Hospital for Special Surgery
Professor of Orthopaedic Surgery and Professor of Public Health, Weill Cornell Medical College

Gregory A. Liguori, MD

Gregory A. Liguori, MD

Anesthesiologist-in-Chief, Hospital for Special Surgery
Attending Anesthesiologist, Hospital for Special Surgery
Clinical Professor of Anesthesiology, Weill Cornell Medical College

Victor M. Zayas, MD

Victor M. Zayas, MD

Associate Attending Anesthesiologist, Hospital for Special Surgery
Assistant Clinical Professor of Anesthesiology and Pediatrics, Weill Cornell Medical College
Director of Pediatric Anesthesiology, Hospital for Special Surgery
Pharmacy & Therapeutics Committee, Hospital for Special Surgery
Laboratory Committee, Hospital for Special Surgery

Michael A. Gordon, MD

Michael A. Gordon, MD

Attending Anesthesiologist, Hospital for Special Surgery
Assistant Clinical Professor in Anesthesiology, Weill Cornell Medical College

Jason Jacobs

Department of Anesthesiology, Hospital for Special Surgery

Jacques T. Ya Deau, MD, PhD

Associate Attending Anesthesiologist, Hospital for Special Surgery
Clinical Associate Professor of Anesthesiology, Weill Cornell Medical College

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.

Level of Evidence: Therapeutic Study Level I.

This article was published online June 2014.
View the full HSS Journal Online First article at springerlink.com.

About the HSS Journal

HSS Journal, an academic peer-reviewed journal published three times a year, February, July and October. The Journal accepts and publishes peer reviewed articles from around the world that contribute to the advancement of the knowledge of musculoskeletal diseases and disorders.

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