Pre- versus postoperative intraarticular application of local anesthetics and opioids versus femoral nerve block in anterior cruciate ligament repair.
BACKGROUND
Often anterior cruciate ligament (ACL) reconstruction is performed as outpatient surgery. This requires a patient friendly postoperative pain management. Three common procedures were compared in this trial.


METHODS
In a prospective, randomized study the effect of postoperative pain management using preoperative intraarticular anesthesia (0.1 mg Fentanyl + 8 ml Bupivacain 0.5%) was compared with postoperative intraarticular anesthesia (0.1 mg Fentanyl + 8 ml Bupivacain 0.5%) and the femoralis 3-in-1 nerve block (20 ml Prilocain 1% + 20 ml Bupivacain 0.5%) in 157 patients who underwent arthroscopic ACL-plasty.


RESULTS
Preoperative intraarticular anesthesia and the femoralis 3-in-1 nerve block showed the same postoperative analgesia and satisfactory pain scores in most cases. Postoperative intraarticular anesthesia was less effective.


CONCLUSIONS
Our data show that in anterior cruciate ligament reconstruction preoperative intraarticular analgesia with Bupivacain/Fentanyl is satisfactory and equal to the femoralis 3-in-1 nerve block with Bupivacain.
Mayr
Hermann O
HO
Department of Orthopedic Surgery, OCM-Clinic, Steinerstr 6, 81369, Munich, Germany. hermann.mayr@ocm-muenchen.de
Entholzner
Elmar
E
Hube
Robert
R
Hein
Werner
W
Weig
Thomas G
TG
D000284:Administration, Oral; D000328:Adult; D000556:Ambulatory Surgical Procedures; D000698:Analgesia / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000768:Anesthesia, General; D000779:Anesthetics, Local; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D001182:Arthroscopy; D002045:Bupivacaine; D005260:Female; D005267:Femoral Nerve / Q000187:drug effects*; D005283:Fentanyl; D006801:Humans; D007270:Injections, Intra-Articular; D007718:Knee Injuries / Q000601:surgery*; D008297:Male; D009407:Nerve Block; D010098:Oxycodone / Q000008:administration & dosage*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011292:Premedication; D011318:Prilocaine; D011446:Prospective Studies; D013585:Synovitis / Q000601:surgery
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D011318:Prilocaine; D010098:Oxycodone; D005283:Fentanyl; D002045:Bupivacaine