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Published in: Knee Surgery, Sports Traumatology, Arthroscopy 2/2014

01-02-2014 | Knee

Local infiltration analgesia is comparable to femoral nerve block after anterior cruciate ligament reconstruction with hamstring tendon graft: a randomised controlled trial

Authors: Pia Kjær Kristensen, Mogens Pfeiffer-Jensen, Jens Ole Storm, Theis Muncholm Thillemann

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 2/2014

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Abstract

Purpose

Arthroscopic anterior cruciate ligament (ACL) reconstruction is a painful procedure requiring intensive postoperative pain management. Femoral nerve block is widely used in ACL surgery. However, femoral nerve block does not cover the donor site of the hamstring tendons. Local infiltration analgesia is a simple technique that has proven effective in postoperative pain management after total knee arthroplasty. Further, local infiltration analgesia covers the donor site and is associated with few complications. It was hypothesised that local infiltration analgesia at the donor site and wounds would decrease pain and opioid consumption after ACL reconstruction with hamstring tendon graft.

Methods

Sixty patients undergoing primary ACL surgery with hamstring tendon graft were randomised to receive either local infiltration analgesia or femoral nerve block. Pain was scored on the numeric rating scale, and use of opioid, range of motion and adverse effects were assessed at the postoperative recovery unit (0 h), 3, 24 and 48 h, postoperatively.

Results

There were no significant differences between the groups in pain intensity or total opioid consumption at any of the follow-up points. Further, there were no differences between groups concerning side effects and range of motion.

Conclusions

Local infiltration analgesia and femoral nerve block are similar in the management of postoperative pain after ACL reconstruction with hamstring tendon graft. Until randomised studies have investigated femoral nerve block combined with infiltration at the donor site, we recommend local infiltration analgesia in ACL reconstruction with hamstring tendon graft.

Level of evidence

I.
Literature
1.
go back to reference Andersen KV, Bak M, Christensen BV, Harazuk J, Pedersen NA, Soballe K (2010) A randomized, controlled trial comparing local infiltration analgesia with epidural infusion for total knee arthroplasty. Acta Orthop 81:606–610PubMedCrossRef Andersen KV, Bak M, Christensen BV, Harazuk J, Pedersen NA, Soballe K (2010) A randomized, controlled trial comparing local infiltration analgesia with epidural infusion for total knee arthroplasty. Acta Orthop 81:606–610PubMedCrossRef
2.
go back to reference Andersen LO, Husted H, Otte KS, Kristensen BB, Kehlet H (2008) High-volume infiltration analgesia in total knee arthroplasty: a randomized, double-blind, placebo-controlled trial. Acta Anaesthesiol Scand 52:1331–1335PubMedCrossRef Andersen LO, Husted H, Otte KS, Kristensen BB, Kehlet H (2008) High-volume infiltration analgesia in total knee arthroplasty: a randomized, double-blind, placebo-controlled trial. Acta Anaesthesiol Scand 52:1331–1335PubMedCrossRef
3.
go back to reference Busch CA, Shore BJ, Bhandari R, Ganapathy S, MacDonald SJ, Bourne RB, Rorabeck CH, McCalden RW (2006) Efficacy of periarticular multimodal drug injection in total knee arthroplasty. A randomized trial. J Bone Joint Surg Am 88:959–963PubMedCrossRef Busch CA, Shore BJ, Bhandari R, Ganapathy S, MacDonald SJ, Bourne RB, Rorabeck CH, McCalden RW (2006) Efficacy of periarticular multimodal drug injection in total knee arthroplasty. A randomized trial. J Bone Joint Surg Am 88:959–963PubMedCrossRef
4.
go back to reference Bushnell BD, Sakryd G, Noonan TJ (2010) Hamstring donor-site block: evaluation of pain control after anterior cruciate ligament reconstruction. Arthroscopy 26:894–900PubMedCrossRef Bushnell BD, Sakryd G, Noonan TJ (2010) Hamstring donor-site block: evaluation of pain control after anterior cruciate ligament reconstruction. Arthroscopy 26:894–900PubMedCrossRef
5.
go back to reference Butterfield NN, Schwarz SK, Ries CR, Franciosi LG, Day B, MacLeod BA (2001) Combined pre- and post-surgical bupivacaine wound infiltrations decrease opioid requirements after knee ligament reconstruction. Can J Anaesth 48:245–250PubMedCrossRef Butterfield NN, Schwarz SK, Ries CR, Franciosi LG, Day B, MacLeod BA (2001) Combined pre- and post-surgical bupivacaine wound infiltrations decrease opioid requirements after knee ligament reconstruction. Can J Anaesth 48:245–250PubMedCrossRef
6.
go back to reference Cederholm I, Akerman B, Evers H (1994) Local analgesic and vascular effects of intradermal ropivacaine and bupivacaine in various concentrations with and without addition of adrenaline in man. Acta Anaesthesiol Scand 38:322–327PubMedCrossRef Cederholm I, Akerman B, Evers H (1994) Local analgesic and vascular effects of intradermal ropivacaine and bupivacaine in various concentrations with and without addition of adrenaline in man. Acta Anaesthesiol Scand 38:322–327PubMedCrossRef
7.
go back to reference Dimmen S, Nordsletten L, Engebretsen L, Steen H, Madsen JE (2009) The effect of parecoxib and indometacin on tendon-to-bone healing in a bone tunnel: an experimental study in rats. J Bone Joint Surg Br 91:259–263PubMedCrossRef Dimmen S, Nordsletten L, Engebretsen L, Steen H, Madsen JE (2009) The effect of parecoxib and indometacin on tendon-to-bone healing in a bone tunnel: an experimental study in rats. J Bone Joint Surg Br 91:259–263PubMedCrossRef
8.
go back to reference Edkin BS, McCarty EC, Spindler KP, Flanagan JF (1999) Analgesia with femoral nerve block for anterior cruciate ligament reconstruction. Clin Orthop Relat Res 369:289–295PubMedCrossRef Edkin BS, McCarty EC, Spindler KP, Flanagan JF (1999) Analgesia with femoral nerve block for anterior cruciate ligament reconstruction. Clin Orthop Relat Res 369:289–295PubMedCrossRef
9.
go back to reference Edwards JZ, Greene KA, Davis RS, Kovacik MW, Noe DA, Askew MJ (2004) Measuring flexion in knee arthroplasty patients. J Arthroplast 19:369–372CrossRef Edwards JZ, Greene KA, Davis RS, Kovacik MW, Noe DA, Askew MJ (2004) Measuring flexion in knee arthroplasty patients. J Arthroplast 19:369–372CrossRef
11.
go back to reference Iskandar H, Benard A, Ruel-Raymond J, Cochard G, Manaud B (2003) Femoral block provides superior analgesia compared with intra-articular ropivacaine after anterior cruciate ligament reconstruction. Reg Anesth Pain Med 28:29–32PubMed Iskandar H, Benard A, Ruel-Raymond J, Cochard G, Manaud B (2003) Femoral block provides superior analgesia compared with intra-articular ropivacaine after anterior cruciate ligament reconstruction. Reg Anesth Pain Med 28:29–32PubMed
12.
go back to reference Jakobsen TL, Christensen M, Christensen SS, Olsen M, Bandholm T (2010) Reliability of knee joint range of motion and circumference measurements after total knee arthroplasty: does tester experience matter? Physiother Res Int 15:126–134PubMedCrossRef Jakobsen TL, Christensen M, Christensen SS, Olsen M, Bandholm T (2010) Reliability of knee joint range of motion and circumference measurements after total knee arthroplasty: does tester experience matter? Physiother Res Int 15:126–134PubMedCrossRef
13.
go back to reference Koh IJ, Chang CB, Seo ES, Kim SJ, Seong SC, Kim TK (2012) Pain management by periarticular multimodal drug injection after anterior cruciate ligament reconstruction: a randomized, controlled study. Arthroscopy 28:649–657PubMedCrossRef Koh IJ, Chang CB, Seo ES, Kim SJ, Seong SC, Kim TK (2012) Pain management by periarticular multimodal drug injection after anterior cruciate ligament reconstruction: a randomized, controlled study. Arthroscopy 28:649–657PubMedCrossRef
15.
go back to reference Mayr HO, Entholzner E, Hube R, Hein W, Weig TG (2007) Pre- versus postoperative intraarticular application of local anesthetics and opioids versus femoral nerve block in anterior cruciate ligament repair. Arch Orthop Trauma Surg 127:241–244PubMedCrossRef Mayr HO, Entholzner E, Hube R, Hein W, Weig TG (2007) Pre- versus postoperative intraarticular application of local anesthetics and opioids versus femoral nerve block in anterior cruciate ligament repair. Arch Orthop Trauma Surg 127:241–244PubMedCrossRef
16.
go back to reference Mehdi SA, Dalton DJ, Sivarajan V, Leach WJ (2004) BTB ACL reconstruction: femoral nerve block has no advantage over intraarticular local anaesthetic infiltration. Knee Surg Sports Traumatol Arthrosc 12:180–183PubMedCrossRef Mehdi SA, Dalton DJ, Sivarajan V, Leach WJ (2004) BTB ACL reconstruction: femoral nerve block has no advantage over intraarticular local anaesthetic infiltration. Knee Surg Sports Traumatol Arthrosc 12:180–183PubMedCrossRef
17.
go back to reference Mulroy MF, Larkin KL, Batra MS, Hodgson PS, Owens BD (2001) Femoral nerve block with 0.25% or 0.5% bupivacaine improves postoperative analgesia following outpatient arthroscopic anterior cruciate ligament repair. Reg Anesth Pain Med 26:24–29PubMed Mulroy MF, Larkin KL, Batra MS, Hodgson PS, Owens BD (2001) Femoral nerve block with 0.25% or 0.5% bupivacaine improves postoperative analgesia following outpatient arthroscopic anterior cruciate ligament repair. Reg Anesth Pain Med 26:24–29PubMed
18.
go back to reference Rosseland LA, Stubhaug A (2004) Gender is a confounding factor in pain trials: women report more pain than men after arthroscopic surgery. Pain 112:248–253PubMedCrossRef Rosseland LA, Stubhaug A (2004) Gender is a confounding factor in pain trials: women report more pain than men after arthroscopic surgery. Pain 112:248–253PubMedCrossRef
19.
go back to reference Schwarz SK, Franciosi LG, Ries CR, Regan WD, Davidson RG, Nevin K, Escobedo S, MacLeod BA (1999) Addition of femoral 3-in-1 blockade to intra-articular ropivacaine 0.2% does not reduce analgesic requirements following arthroscopic knee surgery. Can J Anaesth 46:741–747PubMedCrossRef Schwarz SK, Franciosi LG, Ries CR, Regan WD, Davidson RG, Nevin K, Escobedo S, MacLeod BA (1999) Addition of femoral 3-in-1 blockade to intra-articular ropivacaine 0.2% does not reduce analgesic requirements following arthroscopic knee surgery. Can J Anaesth 46:741–747PubMedCrossRef
20.
go back to reference Spreng UJ, Dahl V, Hjall A, Fagerland MW, Raeder J (2010) High-volume local infiltration analgesia combined with intravenous or local ketorolac + morphine compared with epidural analgesia after total knee arthroplasty. Br J Anaesth 105:675–682PubMedCrossRef Spreng UJ, Dahl V, Hjall A, Fagerland MW, Raeder J (2010) High-volume local infiltration analgesia combined with intravenous or local ketorolac + morphine compared with epidural analgesia after total knee arthroplasty. Br J Anaesth 105:675–682PubMedCrossRef
21.
go back to reference Toftdahl K, Nikolajsen L, Haraldsted V, Madsen F, Tonnesen EK, Soballe K (2007) Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty: a randomized clinical trial. Acta Orthop 78:172–179PubMedCrossRef Toftdahl K, Nikolajsen L, Haraldsted V, Madsen F, Tonnesen EK, Soballe K (2007) Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty: a randomized clinical trial. Acta Orthop 78:172–179PubMedCrossRef
22.
go back to reference Williams BA, Kentor ML, Vogt MT, Vogt WB, Coley KC, Williams JP, Roberts MS, Chelly JE, Harner CD, Fu FH (2004) Economics of nerve block pain management after anterior cruciate ligament reconstruction: potential hospital cost savings via associated postanesthesia care unit bypass and same-day discharge. Anesthesiology 100:697–706PubMedCrossRef Williams BA, Kentor ML, Vogt MT, Vogt WB, Coley KC, Williams JP, Roberts MS, Chelly JE, Harner CD, Fu FH (2004) Economics of nerve block pain management after anterior cruciate ligament reconstruction: potential hospital cost savings via associated postanesthesia care unit bypass and same-day discharge. Anesthesiology 100:697–706PubMedCrossRef
23.
go back to reference Williamson A, Hoggart B (2005) Pain: a review of three commonly used pain rating scales. J Clin Nurs 14:798–804PubMedCrossRef Williamson A, Hoggart B (2005) Pain: a review of three commonly used pain rating scales. J Clin Nurs 14:798–804PubMedCrossRef
24.
go back to reference Wu CL, Bronstein RD, Chen JM, Lee DH, Rouse LM (2000) Postoperative analgesic requirements in patients undergoing arthroscopic anterior cruciate ligament reconstruction. Am J Orthop (Belle Mead NJ) 29:974–978 Wu CL, Bronstein RD, Chen JM, Lee DH, Rouse LM (2000) Postoperative analgesic requirements in patients undergoing arthroscopic anterior cruciate ligament reconstruction. Am J Orthop (Belle Mead NJ) 29:974–978
Metadata
Title
Local infiltration analgesia is comparable to femoral nerve block after anterior cruciate ligament reconstruction with hamstring tendon graft: a randomised controlled trial
Authors
Pia Kjær Kristensen
Mogens Pfeiffer-Jensen
Jens Ole Storm
Theis Muncholm Thillemann
Publication date
01-02-2014
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 2/2014
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-013-2399-x

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