Prolonged motor weakness after femoral nerve block with bupivacaine 0.5%

Lynch, Jonathan R.

doi:10.1111/j.1365-2044.1990.tb14812.x

Cited by 28 publications

(13 citation statements)

References 6 publications

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“…33 In a second prospective study of 211 femoral nerve catheters placed with a stimulating needle technique, complications included 3 ineffective catheters, 12 vascular punctures, and 1 femoral nerve palsy, partially recovered at 12 months. 34 Other cases of femoral nerve palsy have been reported, 14,15 with an incidence rate of block-related neuropathy at 0.22% in one study. 35 Ultrasound-guided blocks were introduced to increase the efficacy and safety of these blocks, but femoral nerve impalement and subtotal intraneural injection during femoral nerve block that was recognized only in retrospect after review of the recorded ultrasound imaging have been reported.…”

Section: Discussionmentioning

confidence: 91%

“…Several case reports have reported rare complications, including complete femoral nerve palsy. [14][15][16] However, subtle adverse effects of femoral nerve block may be more common, with one study suggesting subclinical femoral nerve palsy rates up to 24% as diagnosed by electromyogram (EMG) at 4 weeks following ACL reconstruction. 17 Regaining quadriceps strength and function is crucial to successful rehabilitation after ACL reconstruction, yet there is currently no data analyzing quadriceps function in this setting.…”

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confidence: 99%

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Adverse Effect of Femoral Nerve Blockade on Quadriceps Strength and Function after ACL Reconstruction

et al. 2014

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The purpose of this study was to determine if quadriceps strength and functional outcomes were similar at 6 months following anterior cruciate ligament [ACL] reconstruction in patients receiving a continuous 48-hour femoral nerve blockade for postoperative analgesia (FNB group) versus patients with no FNB (control group). A retrospective cohort was designed including athletes who underwent primary ACL reconstruction with patellar tendon autograft between 2005 and 2010 at our institution with identical rehabilitation protocols. The FNB group included 96 patients with an average age of 21 years and the control group included 100 patients with an average age of 20 years. At 6 months following ACL reconstruction, isokinetic strength (slow and fast activation) and functional tests including vertical jump, single hop, triple hop, and return to sport were analyzed with an α value < 0.05 as significant. Multivariate regression models were used to compare these outcomes between the FNB and control groups after adjusting for gender and competitive athlete status. At 6 months, fast extension isokinetic strength was inferior in the FNB group (78 vs. 85%; p < 0.01). After adjusting for gender and competitive athlete status, fast (p = 0.002) and slow extension strength (p = 0.01), vertical jump (p = 0.03) and single jump (p = 0.02) were also inferior in the FNB group. There were no significant differences in full return to sport between the two groups (86% at 7.5 months in the FNB group vs. 93% at 7.3 months in the control group). In this retrospective comparative study, the hypothesis that patients treated with continuous FNB for postoperative analgesia following ACL reconstruction with patellar tendon autograft will have inferior knee extension (quadriceps) strength and function at 6 months follow-up was affirmed. However, no differences were observed in return to sport, bringing into question whether these statistical differences translate into meaningful clinical consequences after ACL reconstruction. The level of evidence was level III, retrospective case-control series.

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Section: Discussionmentioning

confidence: 91%

mentioning

confidence: 99%

Adverse Effect of Femoral Nerve Blockade on Quadriceps Strength and Function after ACL Reconstruction

et al. 2014

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“…[1][2][3][4] The addition of a femoral nerve block does further reduce postoperative pain but is associated with a variable degree of motor blockade of the quadriceps muscle, which clearly limits its use in outpatients. [5][6][7] Continuous administration of local anaesthetics into the joint by means of elastomeric balloon pump devices and intraarticularly placed catheters could be used in the outpatient setting but has unfortunately not been shown to be effective. 8 Other options to further reduce the incidence and severity of postoperative pain that are not associated with the risk of quadriceps motor dysfunction are, thus, still needed for patients undergoing outpatient anterior cruciate ligament repair.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-guided infrapatellar nerve block for anterior cruciate ligament repair: a prospective, randomised, double-blind, placebo-controlled clinical trial

Lundblad

Forssblad

Eksborg

et al. 2011

European Journal of Anaesthesiology

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“…This also reduces the potential for sameday discharge following day surgery. Reports of prolonged nerve blockade, though rare [7,9,10], raise concerns about the safety of the procedure. Intraarticular infiltration, in contrast, provides good pain relief following knee surgery without the risk of the side effects associated with femoral nerve block [1,2,16].…”

Section: Introductionmentioning

confidence: 99%

BTB ACL reconstruction: femoral nerve block has no advantage over intraarticular local anaesthetic infiltration

Mehdi

Dalton

Sivarajan

et al. 2004

Knee Surgery, Sports Traumatology, Arthroscopy

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Fifty patients were randomly recruited to receive either femoral nerve block (0.375% Bupivacaine) or an intraarticular local anaesthetic injection for pain control for arthroscopically-assisted ACL reconstruction. Both groups were evenly matched for age ( t-test p >0.05). Tourniquet time did not differ significantly between the groups ( t-test p=0.24). The VAS pain levels were not significantly different at 4 h and the first morning postoperatively in both groups. Femoral block (Median VAS: 20 & 18.5) did not confer a significant advantage (Mann Whitney U test p =0.36, 0.67) over intraarticular injection of bupivacaine (Median VAS: 18 & 20). There was no correlation between tourniquet time and postoperative pain ( r=0.19, 0.08). All patients but one were discharged home on the first postoperative morning. Our study demonstrates that pain levels can be sufficiently controlled by intraarticular infiltration of bupivacaine coupled with oral analgesia. The level of pain relief achieved could allow this procedure to be performed in a day surgery setting.

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Prolonged motor weakness after femoral nerve block with bupivacaine 0.5%

Cited by 28 publications

References 6 publications

Adverse Effect of Femoral Nerve Blockade on Quadriceps Strength and Function after ACL Reconstruction

Adverse Effect of Femoral Nerve Blockade on Quadriceps Strength and Function after ACL Reconstruction

Ultrasound-guided infrapatellar nerve block for anterior cruciate ligament repair: a prospective, randomised, double-blind, placebo-controlled clinical trial

BTB ACL reconstruction: femoral nerve block has no advantage over intraarticular local anaesthetic infiltration

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