Comparison of epidural, continuous femoral block and intraarticular analgesia after anterior cruciate ligament reconstruction.
BACKGROUND
The purpose of this study was to compare three locoregional techniques of pain management after arthroscopic anterior cruciate ligament reconstruction (ACLR).


METHODS
Sixty ASA I-II subjects were enrolled after obtaining written informed consent. Patients were randomly allocated to three groups of 20 subjects. The first group (EPI) received epidural ropivacaine 0.2% plus sufentanil 0.2 micro g ml-1, at 5 ml h-1. Patients in the second group (CFB) were given a continuous infusion of the same analgesic mixture through a femoral catheter. The third group (IA) received a continuous intraarticular infusion of ropivacaine 0.2% plus sufentanil 0.2 micro g ml-1, at 5 ml h-1. All subjects were allowed PCA boluses of 5 ml of local anesthetic. Analgesia was assessed for 36 h after the end of surgery by means of a visual analog scale (VAS) and a verbal scale (VS), as well as the number of PCA boluses administered and the amount of supplementary i.v. ketorolac, if given.


RESULTS
The VAS and VS scores were significantly higher in group IA during the 24 h following surgery. Ketorolac requirement was higher in group IA throughout the postoperative observation. Adverse effects were similar in all groups except for urinary retention, which was significantly more frequent in group EPI.


CONCLUSIONS
We conclude that either epidural or continuous femoral nerve block provide adequate pain relief in patients who undergo ACLR, whereas intraarticular analgesia seems unable to cope satisfactorily with the analgesic requirements of this surgical procedure.
Dauri
M
M
Department of Anesthesia and Intensive Care Medicine, University of Rome 'Tor Vergata', Italy. md2888@mclink.it
Polzoni
M
M
Fabbi
E
E
Sidiropoulou
T
T
Servetti
S
S
Coniglione
F
F
Mariani
P
P
Sabato
A F
AF
D000328:Adult; D000577:Amides; D000698:Analgesia / Q000009:adverse effects; D000701:Analgesics, Opioid; D000767:Anesthesia, Epidural / Q000009:adverse effects; D000779:Anesthetics, Local; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D005267:Femoral Nerve; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D009407:Nerve Block / Q000009:adverse effects; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy; D017060:Patient Satisfaction; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000009:adverse effects; D000077212:Ropivacaine; D017409:Sufentanil
D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000077212:Ropivacaine; D017409:Sufentanil