Assessing FNB with and without combined SNB for analgesia in outpatient ACL reconstruction

Study Type: Therapy
OE Level of Evidence: 2
Journal Level of Evidence: N/A
Synopsis
68 patients scheduled for outpatient arthroscopic ACL reconstruction were randomized to be administered either combined single-shot femoral nerve and sciatic nerve blocks (combined ssFSNB), or single-shot femoral nerve block alone (ssFNB). The purpose of this study was to determine if the combined femoral-sciatic nerve block demonstrated significantly lower pain within the post-anaesthesia care unit. Results demonstrated significantly Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Not Reported
Conflicts: None disclosed
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Why was this study needed now?
Continuous femoral nerve blocks are a common method for postoperative analgesia following knee surgery. The combination of both continuous femoral and sciatic nerve blocks has been shown to provide improved analgesia when compared to femoral nerve blocks alone in several randomized controlled trials. The majority of this research has been conducted in patients undergoing total knee arthroplasty, highlighting the need for a trial that assesses the effectiveness of this combination nerve block in outpatient anterior cruciate ligament (ACL) reconstruction.
What was the principal research question?
In outpatient ACL reconstruction, does combined continuous femoral and sciatic nerve block significantly reduce early postoperative pain when compared to single-shot femoral nerve block?
Population: 68 patients scheduled for outpatient arthroscopic ACL reconstruction. All cases were performed under general anesthesia.
Intervention: Combined ssFSNB group: Using in-plane ultrasonographic guidance, femoral nerve and sciatic nerve blocks were performed with injections of 20-30mL 0.5% ropivacaine, each. (n=33 randomized; 32 analyzed) (Mean age: 31.94+/-7.44)
Comparison: ssFNB group: Using in-plane ultrasonographic guidance, a femoral nerve block was performed with an injection of 20-30mL 0.5% ropivacaine. (n=35 randomized; 32 analyzed) (Mean age: 29.47+/-8.16)
Outcomes: The primary outcome was the maximum pain, on a Numeric Rating Scale (NRS; 0-10), experienced within the postanaesthesia care unit. Secondary outcomes included PACU length of stay, the time needed to perform the block, block duration, as well as pain scores at rest and on movement, opioid consumption, opioid-related adverse events, time to first analgesic request, antiemetic consumption, and patient satisfaction over the first 3 days postoperatively.
Methods: RCT; Single-center
Time: Patients were assessed within the PACU and for the first 3 days postoperatively.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.