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  • Continuous Femoral Nerve Block Provides Superior Analgesia Compared With Continuous Intra-articular and Wound Infusion After Anterior Cruciate Ligament Reconstruction

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ORIGINAL ARTICLES
Continuous Femoral Nerve Block Provides Superior Analgesia Compared With Continuous Intra-articular and Wound Infusion After Anterior Cruciate Ligament Reconstruction
  1. Mario Dauri, MD*,
  2. Eleonora Fabbi, MD*,
  3. Pierpaolo Mariani, MD†,
  4. Skerdilajd Faria, MD*,
  5. Roberta Carpenedo, MD*,
  6. Tatiana Sidiropoulou, MD‡,
  7. Filadelfo Coniglione, MD*,
  8. Maria B. Silvi, MD* and
  9. Alessandro F. Sabato, MD*
  1. From the *Department of Anesthesia and Intensive Care Medicine, University Hospital of "Tor Vergata";
  2. †Department of Sport Traumatology, University Institute of Motor Sciences, Rome, Italy; and
  3. ‡2nd Department of Anaesthesiology, University of Athens, "Attikon" Hospital, Athens, Greece.
  1. Address correspondence to: Mario Dauri, MD, Via Di S. Eufemia, 11, 00187 Rome, Italy (e-mail: mario.dauri{at}fastwebnet.it).

Abstract

Background and Objectives: This prospective, randomized, clinical trial compared pain intensity and analgesic drug consumption after anterior cruciate ligament (ACL) reconstruction with patellar tendon under femoral-sciatic nerve block anesthesia in patients who received either a continuous femoral nerve block (CFNB) or continuous local anesthetic wound and intra-articular infusions.

Methods: Fifty patients were randomized to CFNB (n = 25) or an ON-Q device (I-Flow Corp, Lake Forest, Calif) (n = 25). All patients received sciatic nerve block (25 mL of ropivacaine 7.5 mg/mL and clonidine 30 μg). The first group received a CFNB (2 mg/mL of ropivacaine at 7 mL/hr), and the second group received a single-shot femoral nerve block (both using 25 mL of ropivacaine 7.5 mg/mL and clonidine 30 μg). At the end of the intervention, an ON-Q device was positioned on the ON-Q patients to continuously infuse the patellar tendon wound and intra-articular cavity with ropivacaine 2 mg/mL at 2 mL/hr for each catheter. Data regarding demographic, hemodynamic, pain scores, adverse effects, and need for supplemental analgesia were registered in a 36-hr follow-up period.

Results: The CFNB group reported lower visual analog scale values than the ON-Q group: at rest at 12 hrs (2.4 [SD, 2.2] vs 5.4 [SD, 3.1]; P < 0.001) and on movement at 12 (3.1 [SD, 2.5] vs 6.3 [SD, 2.9]; P < 0.001) and 24 hrs (2.7 [SD, 1.9] vs 4.6 [SD, 2.6]; P = 0.01) after surgery. The number of morphine and ketorolac boluses was lower in the CNFB group (morphine: 3.2 [SD, 2.2] vs 6.2 [SD, 2.5]; P < 0.001; ketorolac: 1.1 [SD, 1.0] vs 2.4 [SD, 0.9]; P < 0.001).

Conclusion: Continuous femoral nerve block provides better analgesia than the continuous patellar tendon wound and intra-articular infusions after anterior cruciate ligament reconstruction with patellar tendon.

https://doi.org/10.1097/AAP.0b013e31819baf98

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    Footnotes

    • The work should be attributed to the Department of Anesthesia and Intensive Care Medicine, University Hospital of "Tor Vergata", Rome, Italy.

    • This study was originally accepted for publication on January 27, 2007. Because of a processing error on the part of the journal, publication was unintentionally delayed until now. The editor-in-chief and the managing editor express their sincere apologies to the authors for this unfortunate error.