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.

scholarly journals SURGERIES OF LOWER LIMB UNDER COMBINED FEMORAL AND SCIATIC NERVE BLOCK

2019 ◽  
Vol 3 (8) ◽  
Author(s):  
Dr. Pawan Kumar Agrawal ◽  
Dr. Anil Kumar Gupta
Keyword(s):  
Sciatic Nerve ◽  
Nerve Block ◽  
Lower Limb ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Total Duration ◽  
Sciatic Nerve Block ◽  
Nerve Blocks ◽  
Group A ◽  
Group B

INTRODUCTION:  Peripheral nerve blocks (PNB) can provide surgical anesthesia with better cardiorespiratory stability and is the best option for life-saving procedures  where both general and central neuraxialanesthesia are risky, and no fasting, , or preoperative optimization is required. One of the most useful anesthetic technique is the combination of sciatic and femoral nerve block (3:1) for lower limb surgery. Peripheral nerve blocks are generally suitable for lower limb surgeries because of the peripheral location and the potential to block pain pathways at multiple levels. Also PNBs avoid hemodynamic instability and, facilitate postoperative pain management, and assure a timely discharge of the patient. MATERIAL AND METHODS: In this prospective observational study 50 patients of 22 to 67 years age group of both sexes were included who were posted for lower limb surgeries. Patients were randomly divided into two groups of 25 each. In Group A: 20 ml of 0.5% ropivacaine for femoral nerve block and 20 ml of 0.5% ropivacaine for sciatic nerve block was given to the patients. In group B: 20 ml of 0.5% ropivacaine plus 25 µg fentanyl for femoral nerve block and 20 ml of 0.5% ropivacaine plus fentanyl 25 µg for sciatic nerve block was given. Visual analog scale (VAS) with 0 – 10 cm line was used to see the level of anesthesia in the postoperative period and interpreted as “0” means “no pain” and mark “10” means “severe pain.” Pain score was assessed every 30 min during surgery. If pain is experienced during surgery injection ketamine 0.5 mg/kg intravenously. RESULTS: This study was carried out on 50 patients divided into two groups of 25 each of age group of 22 to 67 years posted for lower limb surgeries. In group A mean age of the patients was 43.78± 12.47and in group B it was 42.33± 13.29. Out of total 25 patients operated in group A 21 (84%) were male and 4 (16%) female, while in group B male and female were 22 (88%) and 3 (12%) respectively. Mean onset of sensory block (Minutes) in group A and Group B was 11.94 ± 3.54 and 12.19 ± 2.67 respectively. Mean onset of motor block in group A was 17.59 ±3.47 minutes and in group B was17.87± 2.78 minutes. Total duration of sensory block in group A was 13.96 ± 0.27 hours and in group B 13.05 ± 0.98 hours. Total duration of motor block in group A was11.58 ± 1.56 hours and in group B12.88 ± 0.96 hours. VAS score was 0 till 8 hours of the study period then it started increasing in both the groups. Patients demanded the first dose of rescue analgesia at 16th hour.  CONCLUSION: Combined femoral-sciatic nerve block is one of the most useful anesthetic procedures and can be used without any major complications, it can also be used in critically ill 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 Defining the minimal effective volume and amount of lidocaine to perform a femoral nerve block under ultrasound control

2020 ◽  
Author(s):  
Valery Piacherski ◽  
Aliaksei Marachkou
Keyword(s):  
Sciatic Nerve ◽  
Nerve Block ◽  
Local Anesthetics ◽  
Peripheral Nerves ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
The Body ◽  
Effective Volume ◽  
Nerve Blocks ◽  
Nerve Blockade

Abstract BackgroundThe application of the combination of local anesthetics (LA) in some parts of the body increases the amount of LA and plasma concentration. The aim of our research was to define the minimal effective volume and amount of lidocaine with added adrenaline (1:200,000) to perform a femoral nerve block under ultrasound control and with neurostimulation. MethodsFemoral nerve blockade was performed with the following lidocaine solutions: 0.75% -10 ml, 7.5 ml; 1% -20ml, 15ml, 10ml, 7.5ml, 5ml; 1.5% -5ml, 4ml; 2% -5 ml, 4 ml; 3% -5ml, 4ml, 3ml; 4% -5 ml, 4 ml, 3 ml, 2.5 ml. All blocks were performed with added adrenaline (1:200,000). In all, 181 blocks of the femoral nerve, in combination with sciatic nerve blocks, were carried out with the help of the electrostimulation of peripheral nerves, and under ultrasound. The quality of motor and sensory blocks was assessed after 45 min of administration of the femoral nerve block. ResultsA total of 181 femoral nerve blocks, in combination with sciatic nerve blocks, were used via the help of electrostimulation of the peripheral nerves (EPN), and under ultrasound (US) control. The femoral nerve blockade was effective with the following lidocaine solutions: 0.75% -10 ml (75mg); 1% -20ml, 15ml, 10ml, 7.5ml (75mg); 1.5% -5ml (75mg); 2% -5 ml (100 mg); 3% -5ml (150mg); 4% -5 ml (200mg). Femoral blockade was ineffective when using the following solutions of lidocaine: 0.75% - 7.5ml (56.25 mg); 1% - 5ml (50mg); 1.5% - 4ml (60mg, No spread along the entire circumference of the nerve - NSAECN); 2% - 4 ml (80mg, NSAECN); 3% - 4ml (120mg NSAECN), 3 ml; 4% - 4 ml (160 mg, NSAECN), 3 ml, 2.5 ml. ConclusionFor a complete motor and sensory block of the femoral nerve: the minimum effective volume of local anesthetics was 5 ml; and the minimum effective amount of lidocaine was 75 mg. А complete block of the femoral nerve was achieved only with the spreading of local anesthetic along the whole circumference of the femoral nerve.

scholarly journals A reduced concentration femoral nerve block is effective for perioperative pain control following ACL reconstruction: a retrospective review

2021 ◽  
Author(s):  
Lukas N. Muench ◽  
Megan Wolf ◽  
Cameron Kia ◽  
Daniel P. Berthold ◽  
Mark P. Cote ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Nerve Block ◽  
Femoral Nerve Block ◽  
Standard Dose ◽  
Cruciate Ligament ◽  
Femoral Nerve ◽  
Retrospective Chart Review ◽  
Single Shot ◽  
Level Of Evidence ◽  
Low Concentration

Abstract Introduction Femoral nerve block (FNB) is a routinely used regional analgesic technique for anterior cruciate ligament (ACL) reconstruction. One method to balance the analgesic effect and functional impairment of FNBs may be to control the concentration of local anesthetics utilized for the block. Materials and methods Retrospective chart review was performed on 390 consecutive patients who underwent ACL reconstruction between June 2014 and May 2017. Patients were divided into those who received a standard (0.5%-bupivacaine) or low (0.1–0.125%-bupivacaine) concentration single-shot FNB performed with ultrasound guidance. Maximum postoperative VAS, Post-Anaesthesia Care Unit (PACU) time prior to discharge, need for additional ‘rescue’ block, and intravenous postoperative narcotic requirements were recorded. Results A total of 268 patients (28.4 ± 11.9 years) were included for final analysis, with 72 patients in the low-concentration FNB group and 196 patients receiving the standard concentration. There were no differences in the maximum postoperative VAS between the low (6.4 ± 2.5) and standard (5.7 ± 2.9) concentration groups (P = 0.08). Similarly, the time from PACU arrival to discharge was not different between groups (P = 0.64). A sciatic rescue block was needed in 22% of patients with standard-dose FNB compared to 30% of patients receiving the low-concentration FNB (P = 0.20). Patients with a hamstring autograft harvest were more likely to undergo a postoperative sciatic rescue block compared to a bone-patellar tendon autograft (P = 0.005), regardless of preoperative block concentration. Quadriceps activation was preserved with low-concentration blocks. Conclusions Using 1/5th to 1/4th the standard local anesthetic concentration for preoperative femoral nerve block in ACL reconstruction did not significantly differ in peri-operative outcomes, PACU time, need for rescue blockade, or additional immediate opioid requirements. Level of Evidence III.

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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