title: Intentional lateral epidural catheter placement for anterior cruciate ligament reconstruction.
abstract: BACKGROUND
  Unilateral epidural block might constitute a clinical option in lower limb orthopedic surgery.
  
  
  METHODS
  Seventy-five patients undergoing anterior cruciate ligament reconstruction (ACLR) were randomized to either a laterally directed epidural catheter (IUEC, n = 40) or a classic midline catheter (CMEC, n = 35). Paresthesia encountered during catheter insertion was registered. The start dose of the anesthetic mixture clonidine 60 microg (0.4 ml), sufentanil 15 microg (0.3 ml) and ropivacaine 10 mg ml(-1)(10.3 ml) in 11 ml of total volume) was set at 5 ml and was increased by 2 ml if anesthesia was inadequate after assessment for sensory blockade to cold and pin-prick. Data were registered intra- and postoperatively regarding pain scores as well as motor block, hemodynamic parameters, adverse effects and need for supplemental analgesia other than a continuous postoperative epidural infusion.
  
  
  RESULTS
  In the IUEC group 80% of patients reported a light paresthesia of the affected side during catheter insertion, whereas 71% of patients in the CMEC group reported no paresthesia at all. The amount of anesthetic used to establish surgical anesthesia was lower in the IUEC group (6.2 +/- 0.8 vs. 8 +/- 1.9 ml, P < 0.001). Motor block (Bromage score) of the unaffected side was significantly lower in the IUEC group (P < 0.001). Pain intensity scores, hemodynamic parameters, and supplemental analgesia given were similar between the two groups except for VAS scores at 12 h postoperatively, which were higher in the CMEC group (P < 0.01). Urinary retention was significantly more frequent in the CMEC group (19/35 vs. 5/40, P < 0.001).
  
  
  CONCLUSIONS
  These results suggest that the IUEC technique is a feasible and efficient method for providing anesthesia and analgesia for ACLR and is associated with a lower consume of anesthetics, less motor block and a reduced incidence of urinary retention.
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Tor Vergata University, Rome, Italy. mario.dauri@fastwebnet.it
authors.forename: M
authors.initials: M
authors.lastname: Dauri
authors.forename: T
authors.initials: T
authors.lastname: Sidiropoulou
authors.forename: E
authors.initials: E
authors.lastname: Fabbi
authors.forename: P P
authors.initials: PP
authors.lastname: Mariani
authors.forename: A F
authors.initials: AF
authors.lastname: Sabato
mesh_terms: D000293:Adolescent; D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects / Q000379:methods*; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D001182:Arthroscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000517:prevention & control; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology / Q000517:prevention & control; D010292:Paresthesia / Q000453:epidemiology; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D015203:Reproducibility of Results