scholarly journals COMPARISON OF CONTINUOUS ADDUCTOR CANAL AND FEMORAL NERVE BLOCKS FOR ANALGESIA AND SPORTS READINESS AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN ADOLESCENT PATIENTS

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0022
Author(s):  
Erica L. Holland ◽  
Robin Robbins ◽  
Daniel K-W. Low ◽  
Adrian Bosenberg ◽  
Viviana Bompadre ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Femoral Nerve ◽  
Return To Sports ◽  
Nerve Blocks ◽  
Pain Scores ◽  
Post Operative Pain ◽  
Adolescent Patients ◽  
Surgical Data ◽  
Anterior Cruciate ◽  
Quadriceps Function

Background: Continuous femoral nerve blocks (cFNB) have become a popular method for post-operative analgesia for patients undergoing anterior cruciate ligament reconstruction (ACLR). However, early weight-bearing and the return of quadriceps function favor a motor sparing block, such as a continuous adductor canal nerve block (cACB). Hypothesis/Purpose: We retrospectively compared cACB to cFNB in adolescent patients undergoing ACLR, assessing early post-operative pain scores, narcotic usage, and patient satisfaction; and return of quadriceps function and sports readiness at six months post-surgery. We hypothesized that cACB compared to cFNB would result in in a greater likelihood of sports readiness at six months without having compromised analgesia in the early post-operative period. Methods: We retrospectively reviewed a consecutive series of adolescent patients who underwent ACLR between January 2016 and September 2018 and received either a cACB or cFNB for post-operative pain management. Patient demographic and surgical data, post-operative pain scores, opioid consumption, satisfaction and complications, dates and results of the Return to Sports (RTS) evaluations were collected from the medical record. Comparisons of categorical and continuous variables between groups were made using the χ 2 test, Spearman correlation test, and one-way ANOVA with Bonferroni adjustment. Results: Ninety-one patients (53 with cFNB, 38 with cACB) were reviewed for post-operative analgesia outcomes and quadriceps function at six months and beyond. Analysis of demographic and surgical data revealed no difference in the make-up of the two groups. There were no significant differences between groups in the total oxycodone use PODs 1-3 ( p = 0.213), daily post-operative pain scores ( p > 0.25), or satisfaction with the blocks ( p = 0.93). There was no difference in time to RTS nor in the percentage of patients who achieved a 90% limb symmetry index for quadriceps strength when comparing the two groups at the six-month mark and beyond ( p = 0.384). Conclusions: We found no difference in post-operative analgesic requirements and high satisfaction in both groups when comparing patients who underwent ACLR with hamstring autograft with a cACB to those who underwent a similar procedure with a cFNB. Readiness for return to sports and return of quadriceps function at six months and beyond does not appear to vary with regional technique, either cACB or cFNB, employed at surgery.

The Influence of Perioperative Nerve Block on Strength and Functional Return to Sports After Anterior Cruciate Ligament Reconstruction

2020 ◽  
Vol 48 (7) ◽  
pp. 1689-1695
Author(s):  
Michelle E. Kew ◽  
Stephan G. Bodkin ◽  
David R. Diduch ◽  
Marvin K. Smith ◽  
Anthony Wiggins ◽  
...  
Keyword(s):  
Nerve Block ◽  
Cruciate Ligament ◽  
Knee Extensor ◽  
Block Type ◽  
Return To Sports ◽  
Nerve Blocks ◽  
Knee Flexor ◽  
Significant Difference ◽  
Ikdc Score ◽  
Anterior Cruciate

Background: Patients often have quadriceps or hamstring weakness after anterior cruciate ligament reconstruction (ACLR), despite postoperative physical therapy regimens; however, little evidence exists connecting nerve blocks and ACLR outcomes. Purpose: To compare muscle strength at return to play in patients who received a nerve block with ACLR and determine whether a specific block type affected subjective knee function. Study Design: Cohort study; Level of evidence, 3. Methods: Patients were recruited 5 to 7 months after primary, isolated ACLR and completed bilateral isokinetic strength tests of the knee extensor/flexor groups as a single-session return-to-sport test. Subjective outcomes were assessed with the International Knee Documentation Committee (IKDC) score. Strength was expressed as torque normalized to mass (N·m/kg) and limb symmetry index as involved/uninvolved torque. Chart review was used to determine the type of nerve block and graft used. Nerve block types were classified as knee extensor motor (femoral nerve), knee flexor motor (sciatic nerve), or isolated sensory (adductor canal block/saphenous nerve). A 1-way analysis of covariance controlling for graft type was used. Results: A total of 169 patients were included. Graft type distribution consisted of 102 (60.4%) ipsilateral bone–patellar tendon–bone (BTB) and 67 (39.6%) ipsilateral hamstring tendon. Nerve block type distribution consisted of 38 (22.5%) femoral, 25 (14.8%) saphenous, 45 (26.6%) femoral and sciatic, and 61 (36.1%) saphenous and sciatic. No significant difference was found in knee extensor strength ( P = .113) or symmetry ( P = .860) between patients with knee extensor motor blocks (1.57 ± 0.45 N·m/kg; 70.1% ± 15.3%) and those without (1.47 ± 0.47 N·m/kg; 69.6% ± 18.8%). A significant difference was found between patients with knee flexor motor blocks (0.83 ± 0.26 N·m/kg) and those without (0.92 ± 0.27 N·m/kg) for normalized knee flexor strength ( P = .21) but not knee flexor symmetry ( P = .592). Controlling for graft type, there were no differences in subjective knee function (IKDC score) between all nerve block groups ( P = .57). Conclusion: Our data showed that use of a sciatic nerve block with ACLR in patients with hamstring and BTB grafts influences persistent knee flexor strength deficits at time of return to sports. Although the cause of postoperative muscular weakness is multifactorial, this study adds to the growing body of evidence suggesting that perioperative nerve blocks affect muscle strength and functional rehabilitation after ACLR.

Effect of Adductor Canal Block Versus Femoral Nerve Block on Quadriceps Strength, Function, and Postoperative Pain After Anterior Cruciate Ligament Reconstruction: A Systematic Review of Level 1 Studies

2019 ◽  
Vol 48 (9) ◽  
pp. 2305-2313 ◽  
Author(s):  
Matthew Dean Edwards ◽  
Joseph Preston Bethea ◽  
Jennifer Lee Hunnicutt ◽  
Harris Scott Slone ◽  
Shane Kelby Woolf
Keyword(s):  
Systematic Review ◽  
Femoral Nerve Block ◽  
Cruciate Ligament ◽  
Femoral Nerve ◽  
Quadriceps Strength ◽  
Pain Scores ◽  
Functional Measures ◽  
Anterior Cruciate ◽  
Straight Leg Raise

Background: Femoral nerve block (FNB) is a popular technique for reducing postoperative pain in patients with anterior cruciate ligament reconstruction (ACLR), but it is also linked to a number of adverse effects, such as quadriceps weakness, antalgic ambulation, and increased fall risk. Adductor canal block (ACB) has been offered as a motor nerve–sparing alternative to FNB. Purpose: To evaluate available literature that compares the effects of ACB and FNB on functional outcomes after arthroscopic ACLR. Study Design: Systematic review. Methods: Following the 2009 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a search of PubMed (Ovid), CINAHL, Scopus, Cochrane, and Google Scholar databases was conducted. Search terms were designed to capture studies comparing the effects of ACB and FNB in patients undergoing arthroscopic ACLR. Data were evaluated regarding study and patient characteristics, functional measures, opioid consumption, pain scores, and complications. Results: Eight randomized controlled trials (N = 655 patients) comparing the efficacy of ACB versus FNB in arthroscopic ACLR were included. The heterogeneity of outcome measures precluded meta-analysis. Seven studies reported functional measures, which included isokinetic strength, straight-leg raise, and other various measures. Follow-up periods varied between 1 hour and 6 months. In 3 trials, ACB was found to preserve quadriceps strength as measured using straight-leg raise for the first 12 to 24 hours after surgery, while 3 other trials found no difference between the groups. No differences were reported in isokinetic strength at 6 months. In other functional measures, ACB either outperformed or was equivalent to FNB. The majority of studies reporting opioid consumption, pain scores, and complications found no differences between the blocks. Conclusion: This systematic review suggests that when compared with FNB, ACB preserves quadriceps function in the early postoperative period after ACLR while providing a similar level of analgesia. Limitations of this study include the use of various functional measures and limited long-term follow-up. More research evaluating long-term functional outcomes with standardized measures is needed to draw adequate conclusions regarding the effects of ACB and FNB on function after ACLR.

scholarly journals FEMORAL NERVE BLOCK VERSUS ADDUCTOR CANAL BLOCK FOR ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN PEDIATRIC AND ADOLESCENT PATIENTS

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0005 ◽  
Author(s):  
Orlando D. Sabbag ◽  
Heath P. Melugin ◽  
Brian T. Samuelsen ◽  
Nancy M. Cummings ◽  
Diane L. Dahm ◽  
...  
Keyword(s):  
Femoral Nerve Block ◽  
Cruciate Ligament ◽  
Statistical Significance ◽  
Vertical Jump ◽  
Univariate Analysis ◽  
Femoral Nerve ◽  
Inclusion Criteria ◽  
Adolescent Patients ◽  
Anterior Cruciate ◽  
Flexion Strength

Background Adductor canal block (ACB) is an alternative method to femoral nerve block (FNB) for post-operative analgesia for anterior cruciate ligament reconstruction (ACLR) in pediatric and adolescent patients. Prior studies have suggested that FNB is associated with persistent strength deficits at 6 months after ACLR in this population. Proponents of the ACB consider that this method may result in a decreased incidence of quadriceps strength deficits during post-operative rehabilitation. The purpose of this study was to compare knee strength and function at 6 and 9 months after ACLR in pediatric and adolescent patients who received FNB versus ACB peri-operatively. Methods Patients 18 years or younger who underwent primary ACLR between 2002 and 2017 at a single institution were identified. ACLR was performed with either a patellar tendon autograft or hamstring autograft. A transphyseal ACLR was performed in patients with open physes. All patients participated in a comprehensive rehabilitation program which included isokinetic strength testing and functional testing at 6 and/or 9 months postoperatively. Patients were excluded if they underwent multiligamentous knee reconstruction, concomitant cartilage restoration procedures, did not receive perioperative FNB or ACB, or if they did not complete isokinetic strength and functional testing at 6 or 9 months. The included cohort was separated into FNB group and ACB group for comparison. Isokinetic extension and flexion strength deficits and functional deficits in vertical jump, single hop, and triple hop between the two groups were compared at both time points. A strength deficit of 15% or less and a functional deficit of 10% or less compared to the contralateral side were considered satisfactory. Univariate analysis was performed to assess for differences in patient demographics and surgical variables. A 1:1 matched subgroup analysis between the two groups was performed to account for possible differences in outcomes associated to graft types, concomitant meniscus repair, and BMI. Results Of the 240 patients identified, 85 patients (64 FNB, 21 ACB) with a mean age of 15.9 years (Range: 11-18) met inclusion criteria for comparison at 6 months and 76 patients (40 FNB, 36 ACB) with a mean age of 15.5 years (Range: 12-17) met inclusion criteria for comparison at 9 months. Univariate analysis showed significantly greater deficits at 6 months in the FNB with respect to fast isokinetic flexion strength (7.7% vs. -4.9%; p = .03). There were no differences in slow isokinetic flexion (10.5% vs. 6.8%; p = .79) and fast isokinetic extension (11.9% vs. 13.9%; p = .68) strength deficits between the groups. There were clinically relevant greater deficits in the FNB group with respect to slow isokinetic extension (19.3% vs. 12.0%; p = .24), but this did not reach statistical significance. This clinical difference in satisfactory scores between the groups with respect to slow isokinetic extension was accentuated with the 1:1 matched outcome trial (23.9% vs. 12.1%; p = .20). With respect to function, there were no differences in deficits for vertical jump (8.4% vs. 4.3%; p = .55), single hop (7.4% vs. 9.3%; p = .65), or triple hop (6.0% vs. 7.1%; p = .77) between the two groups. Univariate analysis showed significant greater deficits at 9 months in the FNB with respect to slow isokinetic flexion strength (9.6% vs. 0.4%; p = .01). There were no differences in fast isokinetic flexion (-0.2% vs. 0.7%; p = .87) and fast isokinetic extension (6.0% vs. 2.7%; p = .51) strength deficits between the groups. There were clinically relevant greater deficits in the FNB group with respect to slow isokinetic extension (17.3% vs -14.0%, p = .19), but this did not reach statistical significance. With respect to function, there were no differences in deficits for vertical jump (5.2% vs. 6.5%, p = .85), single hop (7.7% vs. 6.2%; p = .79), or triple hop (1.9% vs. 3.9%; p = .35) between the two groups. Conclusion Because previous studies have shown a significant delay in return of strength with FNB, ACB began to be employed at our center for post-operative pain control following ACLR in pediatric and adolescent patients. This study showed that pediatric and adolescent patients treated with FNB as a method of post-operative analgesia after ACLR had significantly greater deficits in fast isokinetic flexion at 6 months and slow isokinetic flexion at 9 months compared to those who received ACB. These differences may or may not have clear clinical relevance. However, patients treated with FNB showed clinically relevant greater deficits in slow isokinetic extension strength at 6 and 9 months postoperatively compared to those who received ACB if 85% strength return is used as criteria to return to sport. Pediatric and adolescent patients could benefit from undergoing perioperative analgesia with ACB instead of FNB, but comparison between these two methods of regional anesthesia may require a prospective trial. Level of Evidence Retrospective cohort study, Level IV [Table: see text][Table: see text]

Sign in / Sign up

Export Citation Format

Share Document