title: Intraarticular bupivacaine-clonidine-morphine versus femoral-sciatic nerve block in pediatric patients undergoing anterior cruciate ligament reconstruction.
abstract: We hypothesized that combined femoral-sciatic nerve block (FSNB) offers better analgesia with fewer side effects than intraarticular infiltration (IA) in children undergoing anterior cruciate ligament (ACL) reconstruction. Thirty-six children undergoing ACL reconstruction were randomized to FSNB or IA. FSNB patients had FSNB with bupivacaine (0.125%)-clonidine (2 microg/kg), whereas IA patients received bupivacaine (0.25%)-clonidine (1 microg/kg)-morphine (5 mg). Postoperatively, analgesia was provided with patient-controlled analgesia and rescue morphine. Patient demographics were similar. FSNB patients required less intraoperative fentanyl (50 +/- 40 microg versus 80 +/- 50 microg; P = 0.04). Visual analog scale score for FSNB was smaller than IA in the recovery room (1.8 +/- 3 versus 5.4 +/- 3; P = 0.0002) and during the first 24 h (1.6 +/- 1 versus 2.9 +/- 2; P = 0.01)). FSNB morphine use in the first 18 h was less (7 +/- 13 mg versus 21 +/- 21 mg; P = 0.03). Fewer FSNB patients vomited (11% versus 50%; P = 0.03). IA patients required morphine patient-controlled analgesia sooner. After ACL reconstruction in children, FSNB with bupivacaine-clonidine provides better analgesia with fewer side effects than IA with bupivacaine-clonidine-morphine.
authors.affiliation: Departments of *Anesthesiology and Critical Care Medicine, †Orthopaedic Surgery, and ‡Clinical Research, Children's Hospital of Philadelphia, Pennsylvania.
authors.forename: Kha M
authors.initials: KM
authors.lastname: Tran
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Ganley
authors.forename: Lawrence
authors.initials: L
authors.lastname: Wells
authors.forename: Arjunan
authors.initials: A
authors.lastname: Ganesh
authors.forename: Kimberly I
authors.initials: KI
authors.lastname: Minger
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cucchiaro
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D002045:Bupivacaine / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D003000:Clonidine / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005267:Femoral Nerve; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D009020:Morphine / Q000008:administration & dosage* / Q000009:adverse effects; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D012584:Sciatic Nerve
chemical_list: D009020:Morphine; D003000:Clonidine; D002045:Bupivacaine