Analgesic Impact of a Popliteal Plexus Block to Standard Adductor Canal Block in Arthroscopic Anterior Cruciate Ligament Reconstruction: A Randomized Blind Clinical Trial

Abstract

Background. Damage to the anterior cruciate ligament (ACL) is crippling and often requires an arthroscopic outpatient surgery. Nevertheless, many patients experience severe pain during the first day after ACL reconstruction (ACLR). The adductor canal block (ACB) has yielded conflicting results for post-ACLR pain relief. This research investigated the effect of a supplemental popliteal plexus block on postoperative pain outcomes compared to a sole ACB. Methods. Following a randomized design, 60 cases scheduled for knee arthroscopy with ACLR using an ipsilateral hamstring graft were separated into two categories. Subjects in group A (n = 30) received an ACB only, while subjects in group B (n = 30) received combined ACB and popliteal plexus block (PPB). Results. We found significant differences between the two groups. The time of the first analgesic request (TFR) was later for the combined ACB and PPB (median 8 h) compared to the ACB only group (median 0.5 h). Morphine consumption was lower for patients who received combined ACB and PPB (median 12 mg) compared to ACB only (median 30 mg). The number of the requested doses was lower for the combined ACB and PPB group (median 3 doses) compared to the ACB only group (median 7 doses). Conclusions. The addition of PPB to ACB was associated with improved analgesia and a reduced need for opioid-based sedatives following ACLR with an ipsilateral hamstring graft (https://clinicaltrials.gov/ct2/show/NCT04020133).

Ultrasound-guided popliteal plexus block versus fascia iliaca block for postoperative analgesia after total knee arthroplasty: a randomized clinical trial

“…24 Studies have shown that the PPB approach can be applied safely and effectively to cases experiencing ankle and foot operation, minimizing their pain during the procedure . [25][26][27] Li et al highlighted that PPB group had significant reduction in the pain scores for 4 to 16 h postoperatively; the first analgesic requirement, the side effects, and the frequency with which the patient forced the analgesic, were all less. In group PPB, the time to initiate patientcontrolled analgesia (PCA), the first rescue patientcontrolled analgesia time, and the duration of use of an analgesic pump were all longer than in the control group.…”

A quadruple peripheral nerve block outside the OR for anterior cruciate ligament reconstruction reduces the OR occupancy time

“…In the PACU, patients in the RA group requires less monitoring time [21, 27], because they had fewer side effects given the absence of GA. They also benefited from prolonged analgesic coverage that spared opioid analgesics [42–45]. As early as 2005, Casati et al [46] did a randomized study of 50 knee arthroscopy cases comparing GA with a dual lumbar plexus and sciatic nerve block.…”

Minimizing risk of iatrogenic nerve injury during peroneus longus tendon autograft harvest: a cadaveric study at different ankle or knee positions

“…First, the sample size was small, and the specimens were comprised of cadavers of older age (mean 54 years), which is older than most patients who would need PLT autograft transplantation for ligament reconstruction most commonly following sports injury. Second, the injected watery solution of dyes [19] did not harden and tended to diffuse around the loose, connective tissue under the nerve identified through ultrasound. Third, transducer pressure may have compressed the tissues at the time of ultrasound measurement.…”