Adductor Canal Block Versus Femoral Nerve Block for Pain Control After Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Trial

2018 ◽  
Vol 47 (2) ◽  
pp. 355-363 ◽  
Author(s):  
Jonathan R. Lynch ◽  
Kelechi R. Okoroha ◽  
Vincent Lizzio ◽  
Charles C. Yu ◽  
Toufic R. Jildeh ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Pain Control ◽  
Femoral Nerve Block ◽  
Controlled Trial ◽  
Cruciate Ligament ◽  
Femoral Nerve ◽  
Thigh Circumference ◽  
Randomized Controlled ◽  
Anterior Cruciate ◽  
Straight Leg Raise

Background: Femoral nerve block (FNB) is a commonly performed technique that has been proven to provide effective regional analgesia after anterior cruciate ligament (ACL) reconstruction. The adductor canal block (ACB) uses a similar sensory block around the knee while avoiding motor blockade of the quadriceps muscles. Purpose/Hypothesis: The purpose of our study was to compare the efficacy of FNB versus ACB for pain control after ACL reconstruction. It was hypothesized that there would be no difference in pain levels or opioid requirements between the 2 groups. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: We performed a prospective, double-blinded, randomized controlled trial. Sixty patients undergoing primary ACL reconstruction with bone-patellar tendon-bone autograft were randomized to receive either an ACB or an FNB preoperatively. The primary outcomes assessed were pain levels (visual analog scale) and narcotic requirements for 4 days after surgery. Secondary outcomes included ability to perform a straight leg raise in the recovery room and difference in thigh circumference between the operative and nonoperative leg measured at 7 days postoperatively. Results: Morphine requirements were less in the ACB group in the first 4 hours postoperatively ( P = .02). Aside from this time interval, no differences were found between the 2 groups with regard to opioid requirements and pain scores at any other time. Similarly, no differences were noted in patients’ ability to perform a straight leg raise in the recovery room ( P = .13) or in thigh circumference at the first postoperative visit ( P = .09). Conclusion: The results of our study suggest similar efficacy in perioperative pain control with the use of an ACB for ACL reconstruction when compared with FNB. The potential long-term benefit of quadriceps preservation with the ACB is worthy of future study. Registration: NCT03033589 (ClinicalTrials.gov identifier).

scholarly journals Adductor Canal Block versus Femoral Nerve Block for Pain Control After Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Trial

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0025
Author(s):  
Kelechi R. Okoroha ◽  
Jonathan Lynch ◽  
Vincent Lizzio ◽  
Charles Cong Yu ◽  
Toufic Raja Jildeh ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Nerve Block ◽  
Pain Control ◽  
Femoral Nerve Block ◽  
Cruciate Ligament ◽  
Femoral Nerve ◽  
Thigh Circumference ◽  
Adductor Canal ◽  
Anterior Cruciate ◽  
Straight Leg Raise

Objectives: Regional anesthesia in the form of a femoral nerve block (FNB) is a commonly performed technique that has been proven to provide effective analgesia following anterior cruciate ligament (ACL) reconstruction. The adductor canal nerve block (ANB) employs a similar sensory block around the knee while avoiding motor blockade of the quadriceps. The purpose of our study was to compare the efficacy of FNB versus ANB for pain control following ACL reconstruction. Our hypothesis was that there would be no difference in pain levels or opioid requirements between the two groups. Methods: We performed a prospective, double-blinded, randomized controlled trial. Sixty patients undergoing primary ACL reconstruction using bone-tendon-bone autograft were randomized to receive either an ANB or FNB preoperatively. The primary outcomes assessed were pain levels (visual analog scale) and narcotic requirements for 4 days following surgery. Secondary outcomes included ability to perform a straight leg raise in the recovery room and difference in thigh circumference between the operative and nonoperative leg measured at 7 days postoperatively. Results: Morphine requirements were less in ACB in the first 4 hours postoperatively (p = .02). Aside from this time interval, there were no differences between the 2 groups with regard to opioid requirements and pain scores at any other time. Similarly, no differences were noted in the patient’s ability to perform a straight leg raise in the recovery room (p = .13) or in thigh circumference at the first postoperative visit (p = .09) Conclusion: The results of our study suggest similar efficacy in perioperative pain control with the use of an ANB for ACL reconstruction when compared to FNB. The potential long-term benefit of quadriceps preservation with the ACB is worthy of future study.

scholarly journals Adductor Canal vs. Femoral Nerve Block in Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial

2017 ◽  
Vol 5 (7_suppl6) ◽  
pp. 2325967117S0027
Author(s):  
John W. Xerogeanes ◽  
Ajay Premkumar ◽  
William Godfrey ◽  
Heather Samady ◽  
Michael Brandon Gottschalk ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Ligament Reconstruction ◽  
Femoral Nerve Block ◽  
Controlled Trial ◽  
Cruciate Ligament ◽  
Femoral Nerve ◽  
Cruciate Ligament Reconstruction ◽  
Adductor Canal ◽  
Randomized Controlled ◽  
Anterior Cruciate

Liposomal Bupivacaine for Pain Control After Anterior Cruciate Ligament Reconstruction

2016 ◽  
Vol 44 (7) ◽  
pp. 1680-1686 ◽  
Author(s):  
Ajay Premkumar ◽  
Heather Samady ◽  
Harris Slone ◽  
Regina Hash ◽  
Spero Karas ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Nerve Block ◽  
Pain Control ◽  
Femoral Nerve Block ◽  
Cruciate Ligament ◽  
Femoral Nerve ◽  
Liposomal Bupivacaine ◽  
Postoperative Hematoma ◽  
Anterior Cruciate

Background: Local anesthetics are commonly administered into surgical sites as a part of multimodal pain control regimens. Liposomal bupivacaine is a novel formulation of bupivacaine designed for slow diffusion of a single dose of local anesthetic over a 72-hour period. While early results are promising in various settings, no studies have compared pain management regimens containing liposomal bupivacaine to traditional regimens in patients undergoing anterior cruciate ligament (ACL) reconstruction. Purpose: To evaluate liposomal bupivacaine in comparison with 0.25% bupivacaine hydrochloride (HCl) for pain control after ACL reconstruction. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 32 adult patients undergoing primary ACL reconstruction with a soft tissue quadriceps tendon autograft between July 2014 and March 2015 were enrolled. All patients received a femoral nerve block immediately before surgery. Patients then received either a 40-mL suspension of 20 mL Exparel (1 vial of bupivacaine liposome injectable suspension) and 20 mL 0.9% injectable saline or 20 mL 0.5% bupivacaine HCl and 20 mL 0.9% injectable saline, which was administered into the graft harvest site and portal sites during surgery. Patients were given either a postoperative smartphone application or paper-based journal to record data for 1 week after ACL reconstruction. Results: Of the 32 patients recruited, 29 patients were analyzed (90.6%). Two patients were lost to follow-up, and 1 was excluded because of a postoperative hematoma. There were no statistically significant differences in postoperative pain, medication use, pain location, recovery room time, or mobility between the 2 study groups. Conclusion: There were comparable outcomes with 0.25% bupivacaine HCl at a 200-fold lower cost than liposomal bupivacaine. This study does not support the widespread use of liposomal bupivacaine for pain control after ACL reconstruction in the setting of a femoral nerve block. Registration: ClinicalTrials.gov NCT02189317

scholarly journals A Randomized Controlled Trial of PEEK Versus Titanium Interference Screws for Anterior Cruciate Ligament Reconstruction With 2-Year Follow-up

2019 ◽  
Vol 47 (10) ◽  
pp. 2386-2393 ◽  
Author(s):  
Sarah Shumborski ◽  
Emma Heath ◽  
Lucy J. Salmon ◽  
Justin P. Roe ◽  
James P. Linklater ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Clinical Performance ◽  
Controlled Trial ◽  
Cruciate Ligament ◽  
Cyst Formation ◽  
Metal Artifact ◽  
Interference Screws ◽  
Novel Technique ◽  
Randomized Controlled ◽  
Anterior Cruciate

Background: Graft fixation with interference screws for anterior cruciate ligament (ACL) reconstruction is a highly successful technique. Polyether ether ketone (PEEK) is a novel thermoplastic polymer with high biocompatibility and mechanical properties that mimic native bone, and it can be imaged on computed tomography or magnetic resonance imaging (MRI) without signal flare. Purpose: To compare the clinical performance of ACL reconstruction with PEEK and titanium interference screws at 2 years and to evaluate a novel method of measuring tunnel volume. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 133 patients underwent arthroscopic ACL reconstruction with 4-strand hamstring autografts and were randomized to have titanium or PEEK interference screws for femoral and tibial tunnel fixation. At 2 years, subjective Lysholm and International Knee Documentation Committee scores were assessed and clinical examination performed. At 12 months, MRI was performed to assess graft incorporation and cyst formation, and a novel technique was employed to measure tunnel volumes. Results: There were no significant differences in graft rerupture rate, contralateral ACL rupture rate, subjective outcomes, or objective outcomes. In the titanium and PEEK groups, MRI demonstrated high overall rates of graft integration (96%-100% and 90%-93%, respectively) and ligamentization (89% and 84%) and low rates of synovitis (22% and 10%) and cyst formation (0%-18% and 13%-15%). There was a higher proportion of patients with incomplete graft integration within the femoral tunnel in the PEEK group as compared with the titanium group (10% vs 0%, P = .03); however, the authors suggest that metal artifact precluded proper assessment of the graft in the titanium group by MRI. Tunnel volumes also appeared to be equivalent in the 2 groups and were measured with a novel technique that was highly reproducible in the PEEK group secondary to the absence of flare. Conclusion: Two-year clinical analysis of PEEK interference screws for femoral and tibial fixation of ACL reconstructions showed equivalent clinical performance to titanium interference screws. Given the excellent mechanical characteristics, biological compatibility, and absence of metal artifact on MRI, PEEK has become our material of choice for interference screw fixation in ACL reconstruction.

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