scholarly journals FEMORAL NERVE CATHETER IS ASSOCIATED WITH PERSISTENT STRENGTH DEFICITS AT 6 MONTHS FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN PEDIATRIC PATIENTS

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0020
Author(s):  
Harin B. Parikh ◽  
Tessa N. Mandler ◽  
Alexia G. Gagliardi ◽  
David R. Howell ◽  
Jay C. Albright
Keyword(s):  
Sciatic Nerve ◽  
Acl Reconstruction ◽  
Nerve Block ◽  
Pediatric Patients ◽  
Femoral Nerve ◽  
Sciatic Nerve Block ◽  
Long Term Outcomes ◽  
Single Leg Squat ◽  
Functional Symmetry

Background: The long-term outcomes of femoral nerve blockade following ACL reconstruction are not well defined. Femoral nerve blocks are typically administered as either a single-injection nerve block (FNB) or a continuous femoral nerve catheter (FNC). Prior work among pediatric patients found knee extension and flexion strength deficits 6 months postoperatively using FNB. However, this work was limited by the use of multiple graft choices and orthopedic surgeons. Purpose/Hypothesis: The purpose of this study was to investigate functional recovery after primary ACL surgery with quadriceps tendon-patellar autograft (QPA) in patients receiving a sciatic nerve block and either FNB or FNC. Our hypothesis was that short-term functional performance would be worse among those who underwent FNC compared to FNB. Methods: We conducted a retrospective chart review of pediatric patients 10-19 years of age who underwent ACL reconstruction with QPA by a single orthopedic surgeon. Surgery was performed at two locations: one of which administered FNB and the other FNC. Both were combined with sciatic nerve block. A physical therapist performed functional asymmetry assessments at approximately 6 months postoperative. We compared single-leg squat symmetry between groups using independent samples t-tests. We compared the proportion of patients in each group who achieved 80% symmetry on single-leg squat and Y-Balance tests, had initiated ballistics and running programs, and demonstrated functional symmetry at the 6-month post-operative appointment using Chi-square analyses. Results: Demographics were similar between groups (Table 1). Single leg percent symmetry of the operative limb was significantly greater in the FNB group compared to the FNC group (Table 2). In addition, a greater proportion of those in the FNB group demonstrated functional symmetry compared to the FNC group during the 6-month assessment (Table 2). There were no proportional differences between the groups for the number of patients who demonstrated 80% symmetry during single-leg squat or Y-Balance test, or had initiated a ballistics or running program at the time of assessment. Conclusion: Pediatric patients in the FNC group demonstrated poorer single-leg squat symmetry and functional symmetry compared to those in the FNB group at 7 months following ACL reconstruction with QPA. These preliminary findings may relate to increased concentration and duration of local anesthetic in the FNC group postoperatively. Providers should be cognizant of the implications of FNC on long-term outcomes of ACL reconstruction. [Table: see text][Table: see text]

scholarly journals Effects of the addition of dexamethasone on postoperative analgesia after anterior cruciate ligament reconstruction surgery under quadruple nerve blocks

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yuki Aoyama ◽  
Shinichi Sakura ◽  
Shoko Abe ◽  
Erika Uchimura ◽  
Yoji Saito
Keyword(s):  
Sciatic Nerve ◽  
Acl Reconstruction ◽  
Nerve Block ◽  
Femoral Nerve Block ◽  
Cruciate Ligament ◽  
Femoral Nerve ◽  
Hamstring Tendon ◽  
Sciatic Nerve Block ◽  
University Hospital ◽  
Nerve Blocks

Abstract Background Anterior cruciate ligament (ACL) reconstruction is an invasive surgical procedure for the knee. Quadruple nerve blocks including continuous femoral nerve block and single-injection sciatic, obturator, and lateral femoral cutaneous nerve blocks can provide effective intraoperative anesthesia and analgesia in the early postoperative period. However, severe pain often appears after the effect of single-injection nerve blocks resolves and that is why we conducted two studies. The first study was to determine whether dexamethasone administered along with local anesthetic for sciatic nerve block could prolong the duration of analgesia in patients given quadruple nerve blocks, including continuous femoral nerve block, for ACL reconstruction using a hamstring tendon autograft. The second study was designed to evaluate any difference in effects from dexamethasone administered perineurally versus intravenously. Methods Patients undergoing unilateral arthroscopic ACL reconstruction using a hamstring tendon autograft were enrolled into two studies. The first study was prospectively conducted to see if dexamethasone 4 mg could prolong the duration of analgesia when administered perineurally to the subgluteal sciatic nerve with 0.5% ropivacaine. In the second study, we retrospectively evaluated the effects of intravenous dexamethasone 4 mg as compared with those of perineural dexamethasone to the sciatic nerve block and effects with no dexamethasone. Results In the first study, perineural dexamethasone prolonged the duration of analgesia by 9.5 h (median duration: 22.5 and 13.0 h with and without perineural dexamethasone, respectively, P = 0.011). In the second study, the duration of analgesia was similarly prolonged for intravenous and perineural dexamethasone compared with no dexamethasone. Conclusion Perineural dexamethasone administered along with local anesthetic for single sciatic nerve block prolonged the duration of analgesia of quadruple nerve blocks for ACL reconstruction, however the effects were not different from those of intravenous dexamethasone. Trial registration The protocols of both studies were approved by the Institutional Review Board of Shimane University Hospital, Japan (study number 2821 and 3390 for study 1 and study 2, respectively). Study 1 was registered in University Hospital Medical Information Network Clinical Trials Registry (UMIN000028930). Study 2, which was a retrospective study, was not registered.

Long-term conduction anesthesia of the sciatic nerve in the complex treatment of obliterating atherosclerosis

1993 ◽  
Vol 74 (4) ◽  
pp. 303-303
Author(s):  
V. A. Fominykh ◽  
V. H. Alkhanov
Keyword(s):  
Sciatic Nerve ◽  
Nerve Block ◽  
Posterior Approach ◽  
Therapeutic Agent ◽  
Conduction Block ◽  
Lower Extremities ◽  
Sciatic Nerve Block ◽  
Complex Treatment ◽  
Conduction Anesthesia

Conductive anesthesia as a therapeutic agent for injuries and diseases of the lower extremities is rarely performed. This is primarily due to the fact that the posterior approach is mainly used to perform the sciatic nerve block, which requires special positioning of the patient and is not suitable for inserting a catheter. The most convenient in this respect is the front access to the sciatic nerve. We catheterized the sciatic nerve according to V.V. Kuzmenkov et al. The method of long-term conduction block of the sciatic nerve (DPBS) was performed in 23 patients.

scholarly journals Comparison of continuous femoral nerve block with and without combined sciatic nerve block after total hip arthroplasty: a prospective randomized study

2017 ◽  
Vol 9 (2) ◽  
Author(s):  
Shoji Nishio ◽  
Shigeo Fukunishi ◽  
Tomokazu Fukui ◽  
Yuki Fujihara ◽  
Shohei Okahisa ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Sciatic Nerve ◽  
Total Hip Arthroplasty ◽  
Nerve Block ◽  
Hip Arthroplasty ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Sciatic Nerve Block ◽  
Nerve Blockade ◽  
Continuous Femoral Nerve Block

In association with the growing interests in pain management, several modalities to control postoperative pain have been proposed and examined for the efficacy in the recent studies. Various modes of peripheral nerve block have been proposed and the effectiveness and safety have been examined for each of those techniques. We have described our clinical experiences, showing that continuous femoral nerve block could provide a satisfactory analgesic effect after total hip arthroplasty (THA) procedure. In this study, we compared the effectiveness and safety of continuous femoral nerve block with and without sciatic nerve blockade on pain control after THA. Forty patients scheduled for THA were included in the study and randomly divided into 2 groups. Postoperative analgesic measure was continuous femoral nerve block alone, while the identical regimen of continuous femoral nerve block was combined with sciatic nerve block. The amount of postoperative pain was evaluated in the immediate postoperative period, 6 hours, and 12 hours after surgery. Moreover, postoperative complications as well as requirement of supplemental analgesics during the initial 12 hours after surgery were reviewed in the patient record. The obtained study results showed that the supplemental sciatic nerve blockade provided no significant effect on arrival at the postoperative recovery room, while the NRS pain score was significantly reduced by the combined application of sciatic nerve blockade at 6 and 12 hours after surgery. In the investigation of postoperative analgesiarelated complications, no major complication was encountered without significant difference in complication rate between the groups.

scholarly journals Room A, 10/16/2000 2: 00 PM - 4: 00 PM (PS) Anterior Sciatic Nerve Block and Concerns of Femoral Nerve and Artery Trauma: How Likely Are They? 

2000 ◽  
Vol 93 (3A) ◽  
pp. A-901
Author(s):  
Jerry D. Vloka ◽  
Admir Hadzic ◽  
Mirsad Dupanovic ◽  
Kevin Sanborn ◽  
Daniel  M. Thys
Keyword(s):  
Sciatic Nerve ◽  
Nerve Block ◽  
Femoral Nerve ◽  
Sciatic Nerve Block

scholarly journals Comparison of sciatic nerve block quality achieved using the anterior and posterior approaches: A randomised trial

2019 ◽  
Author(s):  
Abdulkadir Yektaş ◽  
Bedih Balkan
Keyword(s):  
Sciatic Nerve ◽  
Nerve Block ◽  
Diclofenac Sodium ◽  
Randomised Trial ◽  
Femoral Nerve ◽  
Operation Time ◽  
Sciatic Nerve Block ◽  
Nerve Blocks ◽  
Posterior Group ◽  
Group A

Abstract Background: The co-administration of sciatic and femoral nerve blocks can provide anaesthesia and analgesia in patients undergoing lower extremity surgeries. Several approaches to achieve sciatic nerve block have been described, including anterior and posterior approaches. Methods: In total, 58 study patients were randomly assigned to receive either anterior (group A, n=29) or posterior (group P, n=29) sciatic nerve block. Thereafter, the following parameters were determined: sensory and motor block start and end times, time to first fentanyl requirement after blockade but before the start of the operation, time to first fentanyl requirement after the start of the operation, mean fentanyl dose administered after blockade but before the start of the operation, mean fentanyl dose after the start of the operation, time to first diclofenac sodium dose, and total dose of diclofenac sodium required. The trial was retrospectively registered on 11 July 2018. Results: The time to initiation of sensory block was significantly shorter in group P than in group A (7.70±2.05 min and 12.88±4.87 min, respectively; p=0.01). Group P also had a significantly shorter time to first fentanyl requirement after block but before the start of the operation (00.00±00.00 min for group P and 4.05±7.47 min for group A; p<0.01), significantly higher mean fentanyl dose per patient after block but before the start of the operation (44.03±23.78 µg for group P and 31.20±27.79 µg for group A), significantly longer time to first fentanyl requirement after the start of the operation (16.24±7.13 min for group P and 00.00±00.00 min for group A; p=0.01), and significantly lower mean fentanyl dose per patient after the start of the operation (11.51±2.87 µg for group P and 147.75±22.30 µg for group A). Patient satisfaction (p<0.01), anaesthesia quality (p=0.006), and surgical quality (p=0.047) were significantly higher in group P. Conclusions: Anterior and posterior approaches can be used to achieve sciatic nerve block in patients undergoing surgery for malleolar fractures. However, better anaesthesia and pain control results can be obtained if analgesia is administered preoperatively in patients with a posterior approach block and after the start of the operation in patients with an anterior approach block.

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