Single-Shot Versus Continuous Nerve Blocks for Pediatric Anterior Cruciate Ligament Reconstruction: Analgesic Efficacy and Postoperative Outcomes

Abstract

Background: Regional anesthesia is often used to minimize postoperative pain, enable early mobilization, and improve patient/family satisfaction after ACL reconstruction. Little is known about the effects of nerve blocks on patient-reported outcomes and functional outcomes in pediatric ACL reconstruction. This study was performed to compare analgesic efficacy, isokinetic strength testing, and Patient-Reported Outcomes Measurement Information System (PROMIS) scores between single-shot femoral nerve block (SSNB) and femoral nerve catheter (FNC).Methods: Pediatric patients (<18 years old) who underwent primary ACL reconstruction at a tertiary care children's hospital between January 2018 and August 2019 were included. Patients were grouped based on their anesthesia technique (SSNB or FNC) and compared to identify differences in the occurrence of uncontrolled postoperative pain and opioid refills. PROMIS domain scores, active range of motion (AROM), and isokinetic strength testing at multiple timepoints up to 6 months postoperatively were also collected. Linear regression multiple imputation analysis was performed to account for variable outcome measure availability.Results: A total of 78 patients were included (SSNB:42; FNC:36). The groups had similar pain medication needs and pain scores at 1 week postoperatively. The FNC group had significantly longer in-room to incision times (P<0.001), were less likely to return to school by 1 week after surgery (P=0.03), and had lower mobility scores at the 1-week postoperative visit. Patients in the SSNB group had significantly weaker quadriceps function at 3 months (P=0.02), although this difference resolved by the 6-month visit. There were no cases of infection or neuropathy in either group.Conclusion: Our findings indicate that both FNC and SSNB are viable options with similar efficacy for postoperative pain management in pediatric ACL reconstruction. However, we did not find any evidence of superior analgesia with FNC. Additionally, FNC was associated with lower PROMIS mobility scores at 1 week, delayed return to school, and 30 minutes of additional time spent in the operating room. There were no significant differences between groups in terms of function and PROMIS scores at 6 months postoperatively.Level of Evidence: Level III, retrospective cohort studyKey Concepts•Femoral nerve catheter and single-shot femoral blocks are both viable management options for post-ACL reconstruction pain in children and adolescents.•We found that patients who received a femoral nerve block were less likely to return to school and had lower mobility scores at 1 week postoperatively and spent an additional 30 minutes in the operating room.•Both regional anesthesia techniques had similar PROMIS scores and functional outcomes at 6 months postoperatively.