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Nausea, Vomiting, Sleep, and Restfulness Upon Discharge Home After Outpatient Anterior Cruciate Ligament Reconstruction With Regional Anesthesia and Multimodal Analgesia/Antiemesis
  1. Brian A. Williams, M.D., M.B.A.,
  2. Michael L. Kentor, M.D.,
  3. James J. Irrgang, Ph.D., P.T., A.T.C.,
  4. Matthew T. Bottegal, B.S. and
  5. John P. Williams, M.D.
  1. Department of Anesthesiology, University of Pittsburgh, Pittsburgh, PA
  2. Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA.


Background and Objectives We analyzed discharge outcome data after anterior cruciate ligament reconstruction (ACLR) under spinal anesthesia including a perineural femoral catheter and multimodal analgesia/antiemesis. The outcomes specifically addressed in this report are nausea, vomiting, and retching (NVR) and quality of sleep/difficulty falling asleep/daytime restfulness.

Methods ACLR patients were randomized to saline or 0.25% levobupivacaine as a bolus and/or 50-hour infusion. Patients completed the Quality of Recovery 40-item (QoR-40) survey on postoperative days 1 to 4. We analyzed predictors of perfect responses (i.e., no NVR and perfect sleep-restfulness) by pooling these specific QoR-40 items. Prospectively collected QoR-40 data were analyzed retrospectively.

Results Data from 233 participants were analyzed. The addition of the femoral nerve block or perineural catheter did not predict associated improvements in NVR or sleep-restfulness. Previous days' NVR was the most consistent predictor of subsequent NVR, whereas gender and opioid consumption were less consistent predictors. Smoking status was not predictive of NVR. Previous days' sleep-restfulness was a consistent predictor of subsequent sleep-restfulness, whereas the presence of any moderate pain was a less consistent predictor of sleep-restfulness.

Conclusions NVR and quality of sleep-restfulness after the described regional anesthetic with multimodal analgesia and antiemesis is reported. Smoking status was not a predictor of NVR, and gender and opioid consumption were not consistently predictive of NVR. The addition of a femoral nerve block to the described multimodal technique was not associated with NVR or quality of sleep-restfulness.

  • Postoperative nausea and vomiting
  • Anterior cruciate ligament reconstruction
  • Femoral nerve block
  • Spinal anesthesia
  • Quality of life
  • Perphenazine

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  • Supported by National Institutes of Health/National Institute of Arthritis, Musculoskeletal, and Skin Diseases grant K23 AR47631, Bethesda, MD, and International Anesthesia Research Society Clinical Scholar Research Award (2001), Cleveland, OH. Nerve stimulation needles (Prolong PL-50) were provided by Spinal Specialties, Inc., San Antonio, TX; Life-Tech, Inc., Stafford, TX; and I-Flow Corporation, Lake Forest, CA. Elastomeric nerve block infusion devices were provided by McKinley Medical, Wheat Ridge, CO. Patient samples of rofecoxib were provided by Merck & Co., Inc., Whitehouse Station, NJ.

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