Preoperative Sciatic and Femoral Nerve Blocks for Anterior Cruciate Ligament Reconstruction: A Retrospective Analysis

Joshua M Cohen

doi:10.4172/2155-6148.1000452

Abstract

Objective: Uncontrolled postoperative pain and nausea and vomiting are the most common causes for hospital admission following ambulatory anterior cruciate ligament (ACL) reconstruction. Therefore, finding techniques that provide excellent postoperative pain control is of critical importance. This retrospective study compared patients who received preoperative femoral nerve blockade to those who received combined femoral and sciatic nerve blockade. We hypothesized that a combined preoperative nerve block would result in lower postoperative pain, decreased postoperative opioid consumption, and shorter recovery. Methods: The medical records of 191 patients who underwent ACL reconstruction were retrospectively analyzed. We then developed multivariable regression models for each primary outcome parameter. Results: The postoperative pain scores were lower in patients receiving a combined nerve block compared with patients receiving a femoral nerve block (P<0.001) and higher in patients receiving an autograft vs. an allograft (P=0.009). Total morphine equivalents were lower in patients receiving combined nerve block versus patients receiving femoral nerve block (P<0.001) and higher in patients with a higher BMI (P<0.001). Recovery unit length of stay was prolonged by more than 25 minutes in patients with PONV (P=0.001) and in patients who needed a postoperative nerve block in the recovery unit (P ≤ 0.001). Conclusions: A preoperative combined sciatic and femoral nerve block improved postoperative pain management, while postoperative nausea and vomiting or the need for a postoperative nerve block increased the recovery unit time.

Highlights

Pain and postoperative nausea and vomiting (PONV) are the most common causes for hospital admission following ambulatory surgery [1,2]
The postoperative pain scores were lower in patients receiving a combined nerve block compared with patients receiving a femoral nerve block (P
Total morphine equivalents were lower in patients receiving combined nerve block versus patients receiving femoral nerve block (P

Summary

Introduction

Pain and postoperative nausea and vomiting (PONV) are the most common causes for hospital admission following ambulatory surgery [1,2]. The anterior aspect of the knee is innervated by the femoral nerve, while the sciatic nerve innervates the posterior portion of the knee--both of these being potential sources of postoperative pain following reconstruction of the anterior cruciate ligament (ACL). Several studies have examined the benefit of a femoral nerve block in knee surgery. Femoral nerve blockade has been shown to improve analgesia following ACL reconstruction [3,4,5,6] in some studies, but this effect has not been consistently reproduced [7]. Other authors have suggested that epidural anesthesia provides superior analgesia and improved patient satisfaction, but at the cost of urinary retention [9]

Methods

Results

Conclusion