Femoral nerve block: assessment of postoperative analgesia in arthroscopic anterior cruciate ligament reconstruction

Guirro, Úrsula Bueno do Prado; Tâmbara, Elizabeth Milla; Munhoz, Fernanda Reinaldi

doi:10.1016/j.bjane.2013.09.001

Cited by 12 publications

(31 citation statements)

References 31 publications

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“…15 Traditionally, the femoral nerve block (FNB) has been used as the peripheral nerve block of choice for ACL reconstruction, as it has been shown to reliably provide adequate analgesia in a number of randomized trials. 3,4,11,12,19,23,24…”

mentioning

confidence: 99%

Quadriceps Strength Deficits After a Femoral Nerve Block Versus Adductor Canal Block for Anterior Cruciate Ligament Reconstruction: A Prospective, Single-Blinded, Randomized Trial

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Boden

Godfrey

et al. 2018

Orthopaedic Journal of Sports Medicine

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Background:Peripheral nerve blocks, particularly femoral nerve blocks (FNBs), are commonly performed for anterior cruciate ligament (ACL) reconstruction. However, associated quadriceps muscle weakness after FNBs is well described and may occur for up to 6 months postoperatively. The adductor canal block (ACB) has emerged as a viable alternative to the FNB, theoretically causing less quadriceps weakness during the immediate postoperative period, as it bypasses the majority of the motor fibers of the femoral nerve that branch off proximal to the adductor canal.Purpose/Hypothesis:This study sought to identify if a difference in quadriceps strength exists after an ACB or FNB for ACL reconstruction beyond the immediate postoperative period. Beyond the immediate postoperative period, we anticipated no difference in quadriceps strength between patients who received ACBs or FNBs for ACL reconstruction.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:A total of 102 patients undergoing primary ACL reconstruction using a variety of graft types were enrolled between November 2015 and April 2016. All patients were randomized to receive an ACB or FNB before surgery, and the surgeon was blinded to the block type. All patients underwent aggressive rehabilitation without functional bracing postoperatively. The time to the first straight-leg raise was reported by the patient. Isokinetic strength testing was performed at 3 and 6 months postoperatively.Results:Data for 73 patients were analyzed. There was no significant difference in patient demographics of age, body mass index, sex, or tourniquet time between the FNB (n = 35) and ACB (n = 38) groups. The mean time to the first straight-leg raise was similar, at 13.1 ± 1.0 hours for the FNB group and 15.5 ± 1.2 hours for the ACB group (P = .134). The mean extension torque at 60 deg/s increased significantly for both the ACB (53.7% ± 3.4% to 68.3% ± 2.9%; P = .008) and the FNB (53.3% ± 3.3% to 68.5% ± 4.1%; P = .006) groups from 3 to 6 months postoperatively. There was also no significant difference in mean extension torque at 60 deg/s or 180 deg/s between the FNB and ACB groups at 3 and 6 months. There were no significant differences in postoperative complications (infection, arthrofibrosis, retear) between groups.Conclusion:Although prior studies have shown immediate postoperative benefits of ACBs compared with FNBs, with a faster return of quadriceps strength, in the current study there was no statistically or clinically significant difference in quadriceps strength at 3 and 6 months postoperatively in patients who received ACBs or FNBs for ACL reconstruction.

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confidence: 99%

Quadriceps Strength Deficits After a Femoral Nerve Block Versus Adductor Canal Block for Anterior Cruciate Ligament Reconstruction: A Prospective, Single-Blinded, Randomized Trial

Runner

Boden

Godfrey

et al. 2018

Orthopaedic Journal of Sports Medicine

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“…At the same time, they need to prevent drug-related complications, and the techniques need to be successful in the relief of pain. When the management of the analgesia after surgery was adequate, the satisfaction with the procedure and with the medical team was higher [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] .…”

Section: Discussionmentioning

confidence: 99%

“…Matava et al 3 concluded that the use of FNB associated with general anesthesia was safe, despite not having changed the pain scores up to three days after ACLR. Guirro, Tambara and Munhoz 15 noted that patients who received FNB showed a reduction in pain scores. However, there was no difference in the consumption of rescue analgesic.…”

Section: Introductionmentioning

confidence: 95%

“…DOI 10.5935/2595-0118.20180026 Cases of ACLR treated with general anesthesia associated with a peripheral nerve block and/or intra-articular injection 3,[7][8][9][10][11] , epidural anesthesia 12 and spinal anesthesia [4][5][6]13,14 were found. The administration of spinal anesthesia with isobaric bupivacaine combined with FNB with bupivacaine at 0.5% has been previously evaluated 15 . However, the technique associated with fentanyl has not been described in the literature so far.…”

Section: Introductionmentioning

confidence: 99%

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Spinal anesthesia with bupivacaine and fentanyl associated with femoral nerve block in postoperative analgesia in the reconstruction of the anterior cruciate ligament

Guirro¹,

Tâmbara²,

Petterle³

2018

Brazilian Journal of Pain

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BACKGROUND AND OBJECTIVES: To evaluate postoperative analgesia and the need for tramadol in patients undergoing reconstruction of the anterior cruciate ligament with spinal anesthesia, fentanyl and femoral nerve block. METHODS: 166 patients were divided into four groups (G). All patients received spinal anesthesia with 15mg of isobaric bupivacaine at 0.5%. In the G2 and G3 groups, 25µg of fentanyl was associated with bupivacaine and in groups G3 and G4 femoral nerve block was associated with 100mg of bupivacaine at 0.5%, without vasoconstrictor. Patients received timed dipyrone and ketoprofen and were instructed to request tramadol if the pain was ≥4 on the numerical scale. After 6, 12 and 24 hours of spinal anesthesia, the score was recorded on the numerical scale, the request of tramadol and adverse events. RESULTS: Mean pain scores at 6 and 24 hours were not different. In the 12-hour evaluation, there was a difference only in G4 in relation to G1 (p=0.01). Tramadol was requested by 46.7% in G1, 52.9% in G2, 18.6% in G3 and 36.4% in G4 (p=0.009), with a difference between G1 and G3 and also between G2 and G3. CONCLUSION: The association of spinal anesthesia and femoral nerve block in G4 provided lower pain scores in the evaluation at 12 hours after anesthesia. On the other hand, the highest indices were observed in G2, spinal anesthesia with fentanyl. Pain scores at 6 and 12 hours were similar. The highest consumption of analgesics occurred in those who reported more pain in G2.

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“…Given the innervation of the quadriceps, femoral nerve blocks have been implicated in lower limb weakness, delayed mobilisation and a risk of falls . For example, Kwofie et al.…”

Section: Analgesic Strategiesmentioning

confidence: 99%

Analgesic strategies for day‐case knee surgery

Wojcikiewicz

El‐Boghdadly

2019

Anaesthesia

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Femoral nerve block: assessment of postoperative analgesia in arthroscopic anterior cruciate ligament reconstruction

Cited by 12 publications

References 31 publications

Quadriceps Strength Deficits After a Femoral Nerve Block Versus Adductor Canal Block for Anterior Cruciate Ligament Reconstruction: A Prospective, Single-Blinded, Randomized Trial

Quadriceps Strength Deficits After a Femoral Nerve Block Versus Adductor Canal Block for Anterior Cruciate Ligament Reconstruction: A Prospective, Single-Blinded, Randomized Trial

Spinal anesthesia with bupivacaine and fentanyl associated with femoral nerve block in postoperative analgesia in the reconstruction of the anterior cruciate ligament

Analgesic strategies for day‐case knee surgery

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