Abstract
BackgroundAnterior cruciate ligament (ACL) reconstruction is an invasive surgical procedure for the knee. Quadruple nerve blocks including continuous femoral nerve block and single-injection sciatic, obturator, and lateral femoral cutaneous nerve blocks can provide effective intraoperative anesthesia and analgesia in the early postoperative period. However, severe pain often appears after the effect of single-injection nerve blocks resolves and that is why we conducted two studies. The first study was to determine whether dexamethasone administered along with local anesthetic for sciatic nerve block could prolong the duration of analgesia in patients given quadruple nerve blocks, including continuous femoral nerve block, for ACL reconstruction using a hamstring tendon autograft. The second study was designed to evaluate any difference in effects from dexamethasone administered perineurally versus intravenously.MethodsPatients undergoing unilateral arthroscopic ACL reconstruction using a hamstring tendon autograft were enrolled into two studies. The first study was prospectively conducted to see if dexamethasone 4 mg could prolong the duration of analgesia when administered perineurally to the subgluteal sciatic nerve with 0.5% ropivacaine. In the second study, we retrospectively evaluated the effects of intravenous dexamethasone 4 mg as compared with those of perineural dexamethasone to the sciatic nerve block and effects with no dexamethasone.ResultsIn the first study, perineural dexamethasone prolonged the duration of analgesia by 9.5 h (median duration: 22.5 and 13.0 h with and without perineural dexamethasone, respectively, P = 0.011). In the second study, the duration of analgesia was similarly prolonged for intravenous and perineural dexamethasone compared with no dexamethasone.ConclusionPerineural dexamethasone administered along with local anesthetic for single sciatic nerve block prolonged the duration of analgesia of quadruple nerve blocks for ACL reconstruction, however the effects were not different from those of intravenous dexamethasone.Trial registrationThe protocols of both studies were approved by the Institutional Review Board of Shimane University Hospital, Japan (study number 2821 and 3390 for study 1 and study 2, respectively). Study 1 was registered in University Hospital Medical Information Network Clinical Trials Registry (UMIN000028930). Study 2, which was a retrospective study, was not registered.
Highlights
Since the knee joint and its overlying skin and muscle receive innervation from the lumbar plexus and sciatic nerve, a combination of peripheral nerve blocks may be required for intra- and postoperative pain management in knee surgery
We conducted a series of two studies to see 1) if dexamethasone 4 mg administered along with local anesthetic for the subgluteal sciatic nerve block could prolong the duration of analgesia after quadruple nerve blocks including continuous femoral nerve block in patients undergoing Anterior cruciate ligament (ACL) reconstruction using a hamstring autograft and 2) how the effects of perineural dexamethasone differed from those of dexamethasone administered intravenously
An anesthesiologist who was not involved in the block procedure, anesthesia or postoperative measurements prepared the local anesthetic solution used for sciatic nerve block without labeling for group allocation
Summary
Since the knee joint and its overlying skin and muscle receive innervation from the lumbar plexus and sciatic nerve, a combination of peripheral nerve blocks may be required for intra- and postoperative pain management in knee surgery. Quadruple nerve blocks including continuous femoral nerve block and single-injection subgluteal sciatic, obturator and lateral cutaneous femoral nerve blocks have been shown to provide effective intraoperative anesthesia and postoperative analgesia [1]. We conducted a series of two studies to see 1) if dexamethasone 4 mg administered along with local anesthetic for the subgluteal sciatic nerve block could prolong the duration of analgesia after quadruple nerve blocks including continuous femoral nerve block in patients undergoing ACL reconstruction using a hamstring autograft and 2) how the effects of perineural dexamethasone differed from those of dexamethasone administered intravenously. The first study was to determine whether dexamethasone administered along with local anesthetic for sciatic nerve block could prolong the duration of analgesia in patients given quadruple nerve blocks, including continuous femoral nerve block, for ACL reconstruction using a hamstring tendon autograft. The second study was designed to evaluate any difference in effects from dexamethasone administered perineurally versus intravenously
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