Femoral Nerve Block Is Associated With Persistent Strength Deficits at 6 Months After Anterior Cruciate Ligament Reconstruction in Pediatric and Adolescent Patients

Luo, T. David; Ashraf, Ali; Dahm, Diane L.; Stuart, Michael J.; McIntosh, Amy L.

doi:10.1177/0363546514559823

Cited by 107 publications

(87 citation statements)

References 44 publications

(54 reference statements)

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“…As the average duration of these blocks in adults is typically <12 hours, and physical rehabilitation does not usually begin until postoperative day 1, the significance of the degree of motor block is unclear 21. However, persistent weakness in knee extension and flexion after FNB for ACL reconstruction have been recently reported 22. Any contribution of the density of motor block and local anesthetic concentration to this issue is unclear.…”

Section: Discussionmentioning

confidence: 99%

Femoral nerve blockade using various concentrations of local anesthetic for knee arthroscopy in the pediatric population

Veneziano¹,

Tripi²,

Tumin³

et al. 2016

JPR

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BackgroundFemoral nerve blockade (FNB) provides effective postoperative analgesia in children undergoing arthroscopic knee surgery as evidenced by their opioid-sparing effects and decreased postoperative pain scores. Increasing the local anesthetic concentration in peripheral nerve blockade for adults undergoing orthopedic surgery has been shown to be beneficial, increasing block success rate, and providing a longer duration of analgesia. The effect of increasing the concentration of local anesthetic in extremity blocks in children remains largely unexplored.MethodsWe retrospectively evaluated the effectiveness of FNB using three concentrations of local anesthetic (ropivacaine 0.2%, bupivacaine 0.25%, and ropivacaine 0.5%) in children and adolescents undergoing arthroscopic knee surgery. The primary outcome evaluated was postoperative opioid consumption before discharge. Secondary outcomes included post-anesthesia care unit (PACU) and hospital discharge times, first pain score in PACU, and the incidence of adverse events.ResultsTwo hundred and sixty-nine children and adolescents who received a FNB for arthroscopic knee surgery from January 2010 to December 2013 were included for analysis. Local anesthetic used in FNB was ropivacaine 0.2% in 116 (43%) cases, ropivacaine 0.5% in 75 (28%) cases, and bupivacaine 0.25% in 78 (29%) cases. Median postoperative opioid consumption (mg/kg intravenous morphine equivalents) in the ropivacaine 0.5% group was 0 mg/kg (interquartile ranges [IQR]: 0 mg, 0.03 mg/kg) compared to 0.02 mg/kg (IQR: 0, 0.08 mg/kg) in the ropivacaine 0.2% group and 0.01 mg/kg (IQR: 0, 0.08 mg/kg) in the bupivacaine 0.25% group (p=0.009). Median PACU time was shortest in the ropivacaine 0.5% group (47 min; IQR: 36, 68 min) compared to the ropivacaine 0.2% (58 min; IQR: 41, 77) and bupivacaine 0.25% (54 min; IQR: 35, 75 min) groups (p=0.040). Among groups, there were no significant differences in first postoperative pain scores or incidence of nausea and vomiting. No patient in any group experienced a serious adverse event.ConclusionThe results suggest that ropivacaine 0.5% for FNB offers superior postoperative analgesia in the form of decreased postoperative opioid consumption and earlier PACU/hospital discharge, when compared to ropivacaine 0.2% and bupivacaine 0.25% in the pediatric population.Level of evidenceIII, Retrospective Comparative Study.

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Section: Discussionmentioning

confidence: 99%

Femoral nerve blockade using various concentrations of local anesthetic for knee arthroscopy in the pediatric population

Veneziano¹,

Tripi²,

Tumin³

et al. 2016

JPR

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“…A recent study evaluated knee strength and function 6 months after ACL reconstruction in pediatric and adolescent patients and noted that those patients that received a femoral nerve block had weaker quadriceps and hamstring muscles in several testing categories. Although no differences in functional testing were identified between groups, those who did not receive a block were more likely to meet criteria for return to sport at 6 months [65]. Postoperative rehabilitation also plays an important role in safely returning young athletes back to sport.…”

Section: Post-operative Considerationsmentioning

confidence: 91%

Anterior cruciate ligament reconstruction in skeletally immature patients

Pennock

Murphy

2016

Curr Rev Musculoskelet Med

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The management of pediatric patients with an anterior cruciate ligament (ACL) tear can be a challenging endeavor for physicians, athletic trainers, coaches, and parents alike. In particular, the significant longitudinal growth that arises from the physes about the knee creates a unique set of circumstances that must be considered in this patient population. The purpose of this review is to provide a summary of the most recent current literature for the management of skeletally immature patients with an ACL tear.

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“…The use of femoral nerve block during surgery has been associated with prolonged quadriceps weakness and risk of delayed return to sports. 40 …”

Section: Imagingmentioning

confidence: 99%

Anterior cruciate ligament injuries in children and adolescents

Brey

Collis

2015

Current Orthopaedic Practice

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Anterior cruciate ligament (ACL) tears in children and adolescents are becoming more common. While early literature supported a delay of treatment until skeletal maturity, recent studies have supported early ACL reconstruction to prevent additional meniscal or cartilaginous injury. Several different treatment options are available for the skeletally immature patient. Surgical options include transphyseal ACL reconstruction similar to that performed in adults, hybrid techniques, and all-epiphyseal techniques. This review describes the natural history, diagnosis, imaging, and treatment options available for ACL tears in young patients with emphasis on articles published within the past 12 mo.

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Femoral Nerve Block Is Associated With Persistent Strength Deficits at 6 Months After Anterior Cruciate Ligament Reconstruction in Pediatric and Adolescent Patients

Cited by 107 publications

References 44 publications

Femoral nerve blockade using various concentrations of local anesthetic for knee arthroscopy in the pediatric population

Femoral nerve blockade using various concentrations of local anesthetic for knee arthroscopy in the pediatric population

Anterior cruciate ligament reconstruction in skeletally immature patients

Anterior cruciate ligament injuries in children and adolescents

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