School of Medicine and Health Sciences Poster Presentations

Title

Impact of Adductor Canal Saphenous Nerve Block on Perioperative Pain Management for Children Undergoing Anterior Cruciate Ligament Repair: A Retrospective Study

Document Type

Poster

Status

Medical Student

Abstract Category

Clinical Specialties

Keywords

Nerve Block, Anesthesia, Children, ACL, Reconstruction

Publication Date

Spring 2018

Abstract

Background: Anterior cruciate ligament (ACL) reconstruction is a common orthopedic procedure that is associated with significant postoperative pain. Femoral nerve blocks (FNB) provide better analgesia and decrease opioid requirements after ACL reconstruction compared to intra-articular local anesthetic. However, FNBs are associated with decreased quadriceps and hamstring strength, which may delay healing and present an increased risk for falls. There is increasing interest in performing adductor canal saphenous nerve blocks (SNB) for ACL reconstruction, which provide a purely sensory blockade to the knee.

Objective: To compare the perioperative opioid requirements and immediate postoperative outcomes following SNB vs. FNB in children undergoing general anesthesia for ACL reconstruction.

Methods: This is a retrospective study of 105 patients, ages 11 through 18, who underwent ACL reconstruction at Children's National Health System between July 2014 and July 2017. As part of their intraoperative anesthetic management, patients received a FNB, SNB, SNB with local anesthesia, or local anesthesia alone depending on surgeon preference. Intraoperative, postoperative, and perioperative opioid requirements were examined along with use of other rescue analgesics, postoperative pain scores, post anesthesia care unit (PACU) length of stay, and admission rate.

Results: With the exception of gender, no significant differences were observed between the groups in regards to demographics. Males more commonly received a FNB, SNB with local anesthesia and local anesthesia alone while females more commonly received a SNB (0.041). There was no difference in ASA class, length of surgery, length of tourniquet time, and whether additional procedures were performed. Total intraoperative morphine milligram equivalents (MME) and total perioperative MME were significantly greater in patients who received local only vs. a FNB (p=0.018 and p=0.035) and vs. a SNB (p<0.001 and p<0.001). No significant difference in total intraoperative and total perioperative MME was observed between patients receiving a FNB vs. a SNB. There were no significant difference in postoperative pain scores, PACU length of stay, admission rates, and postoperative MME between the groups.

Conclusions:

Both FNBs and SNBs significantly decreased intraoperative and perioperative opioid use compared to local anesthesia only in pediatric ACL reconstruction. While both blocks led to similar analgesic efficacy and opioid use, a SNB may be a safer option due to the purely sensory blockade and sparing of quadriceps and hamstring weakness. More studies should be conducted on adductor canal SNBs to further validate its usefulness in children undergoing ACL repair.

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Impact of Adductor Canal Saphenous Nerve Block on Perioperative Pain Management for Children Undergoing Anterior Cruciate Ligament Repair: A Retrospective Study

Background: Anterior cruciate ligament (ACL) reconstruction is a common orthopedic procedure that is associated with significant postoperative pain. Femoral nerve blocks (FNB) provide better analgesia and decrease opioid requirements after ACL reconstruction compared to intra-articular local anesthetic. However, FNBs are associated with decreased quadriceps and hamstring strength, which may delay healing and present an increased risk for falls. There is increasing interest in performing adductor canal saphenous nerve blocks (SNB) for ACL reconstruction, which provide a purely sensory blockade to the knee.

Objective: To compare the perioperative opioid requirements and immediate postoperative outcomes following SNB vs. FNB in children undergoing general anesthesia for ACL reconstruction.

Methods: This is a retrospective study of 105 patients, ages 11 through 18, who underwent ACL reconstruction at Children's National Health System between July 2014 and July 2017. As part of their intraoperative anesthetic management, patients received a FNB, SNB, SNB with local anesthesia, or local anesthesia alone depending on surgeon preference. Intraoperative, postoperative, and perioperative opioid requirements were examined along with use of other rescue analgesics, postoperative pain scores, post anesthesia care unit (PACU) length of stay, and admission rate.

Results: With the exception of gender, no significant differences were observed between the groups in regards to demographics. Males more commonly received a FNB, SNB with local anesthesia and local anesthesia alone while females more commonly received a SNB (0.041). There was no difference in ASA class, length of surgery, length of tourniquet time, and whether additional procedures were performed. Total intraoperative morphine milligram equivalents (MME) and total perioperative MME were significantly greater in patients who received local only vs. a FNB (p=0.018 and p=0.035) and vs. a SNB (p<0.001 and p<0.001). No significant difference in total intraoperative and total perioperative MME was observed between patients receiving a FNB vs. a SNB. There were no significant difference in postoperative pain scores, PACU length of stay, admission rates, and postoperative MME between the groups.

Conclusions:

Both FNBs and SNBs significantly decreased intraoperative and perioperative opioid use compared to local anesthesia only in pediatric ACL reconstruction. While both blocks led to similar analgesic efficacy and opioid use, a SNB may be a safer option due to the purely sensory blockade and sparing of quadriceps and hamstring weakness. More studies should be conducted on adductor canal SNBs to further validate its usefulness in children undergoing ACL repair.