Saphenous nerve block is an effective regional technique for post-menisectomy pain

Abstract

In this study we have evaluated the post menisectomy pain relief offered by Saphenous nerve block. This study was planned on 40 patients with a pre-operative and post operative diagnosis of medial meniscus lesion undergoing partial menisectomy arthroscopically. Patients were randomized into 2 groups where Group I received a preoperative Saphenous block while group 2 did not receive a peripheral block, but received 1 ml of saline as placebo injection. After blocks both groups received general anesthesia and IV patient controlled analgesia (PCA) with tramadol for post operative pain relief. Patients rest and activity pain scores were evaluated on post operative 0, 2, 4, 6, 12 and 24 h using visual analog scale (VAS). Total tramadol consumption as well as pain at rest, when weight bearing and the need for external support while walking were recorded. Group I VAS scores were statistically lower then group II during the time of observation periods at rest as well as active movement periods. Tramadol consumption through IV PCA was statistically significantly lower in group I than in group II (P < 0.05). Pain during walking measured at 24 h was significantly different with better results in group I (P < 0.001). Saphenous nerve block is used for different indications; it can also be a good analgesic method for arthroscopic interventions. We have shown it to be effective after medial partial menisectomies. According to our knowledge this report is the first one utilizing saphenous nerve block for pain after arthroscopic medial menisectomy.

Postoperative numbness of the knee following total knee arthroplasty

“…Femoral nerve blockade has a low risk of complications including short-term quadriceps dysfunction, femoral neuritis and residual numbness. 13,14 Saphenous nerve blockade has to date only been assessed in patients treated by arthroscopic partial menisectomy 15 but is being studied currently to assess its suitability for patients undergoing TKA (ClinicalTrials.gov identifier NCT01333943). Further studies could therefore assess patients for objective and subjective sensory changes after the use of saphenous and femoral nerve blocks in comparison with those treated without nerve blocks for postoperative analgesia.…”

Ultrasound-guided adductor canal block for arthroscopic medial meniscectomy: a randomized, double-blind trial

“…21,22 A previous study on arthroscopic medial meniscectomy using landmark techniques for a more distal approach to the saphenous nerve block showed a greater clinical effect in the reduction of NRS scores when compared with our study. 5 Nevertheless, we hypothesize that this larger clinical difference in pain score reduction was due to three important methodological differences: 1) subjects were not given intraoperative opioids; 2) subjects were not given preemptive multimodal analgesia; and 3) surgeons did not inject the arthroscopic port sites with local anesthetic. In our view, some, if not all, of these methods are becoming common practice and should be incorporated into any investigation that looks at differences in clinical outcomes for this surgery.…”

“…16 Using several prior studies on similar surgical procedures, our power analysis assumed a baseline NRS score of 5 without a peripheral nerve block. 5,17,18 Therefore, in order for our study to detect a 40% reduction in NRS pain scores between groups immediately postoperatively, 24 subjects per group were required to provide the necessary power (90%) for this study. One additional patient per group was enrolled to account for patient drop-out or loss to follow-up.…”

“…4 A transsartorial landmark-based distal approach to the saphenous nerve block has been shown to reduce pain significantly by providing sensory block to the tissues around the medial meniscus. 5 The saphenous nerve, a terminal branch of the femoral nerve, provides cutaneous sensation to the peripatellar region and the medial aspect of the lower extremity below the knee as well as to the articular branches to the medial aspect of the knee joint. The saphenous nerve separates from the femoral nerve in the proximal third of the thigh, courses through the adductor canal with the nerve to the vastus medialis, and emerges from the adductor hiatus to divide into the infrapatellar branch and the sartorial branch.…”

Efficacy of an ultrasound-guided subsartorial approach to saphenous nerve block: a case series

“…1 It can also be utilized independently for procedures involving only the medial aspect of the distal leg. 2 In a recent study, Benzon et al compared the success rates of five different non-ultrasound approaches to the saphenous nerve block (perifemoral, transsartorial, block at the medial femoral condoyle, below-the-knee field block, and blockade at the level of the medial malleolus), and they found that the transsartorial approach was best able to provide sensory blockade to the medial aspects of the leg and foot, with a success rate of 100% for the medial leg and 80% for the medial foot (n = 10). 3 The use of ultrasound has recently been advocated as a means to facilitate the administration of the saphenous nerve block.…”