title: Continuous femoral nerve block provides superior analgesia compared with continuous intra-articular and wound infusion after anterior cruciate ligament reconstruction.
abstract: OBJECTIVE
  This prospective, randomized, clinical trial compared pain intensity and analgesic drug consumption after anterior cruciate ligament (ACL) reconstruction with patellar tendon under femoral-sciatic nerve block anesthesia in patients who received either a continuous femoral nerve block (CFNB) or continuous local anesthetic wound and intra-articular infusions.
  
  
  METHODS
  Fifty patients were randomized to CFNB (n = 25) or an ON-Q device (I-Flow Corp, Lake Forest, Calif) (n = 25). All patients received sciatic nerve block (25 mL of ropivacaine 7.5 mg/mL and clonidine 30 microg). The first group received a CFNB (2 mg/mL of ropivacaine at 7 mL/hr), and the second group received a single-shot femoral nerve block (both using 25 mL of ropivacaine 7.5 mg/mL and clonidine 30 microg). At the end of the intervention, an ON-Q device was positioned on the ON-Q patients to continuously infuse the patellar tendon wound and intra-articular cavity with ropivacaine 2 mg/mL at 2 mL/hr for each catheter. Data regarding demographic, hemodynamic, pain scores, adverse effects, and need for supplemental analgesia were registered in a 36-hr follow-up period.
  
  
  RESULTS
  The CFNB group reported lower visual analog scale values than the ON-Q group: at rest at 12 hrs (2.4 [SD, 2.2] vs 5.4 [SD, 3.1]; P < 0.001) and on movement at 12 (3.1 [SD, 2.5] vs 6.3 [SD, 2.9]; P < 0.001) and 24 hrs (2.7 [SD, 1.9] vs 4.6 [SD, 2.6]; P = 0.01) after surgery. The number of morphine and ketorolac boluses was lower in the CNFB group (morphine: 3.2 [SD, 2.2] vs 6.2 [SD, 2.5]; P < 0.001; ketorolac: 1.1 [SD, 1.0] vs 2.4 [SD, 0.9]; P < 0.001).
  
  
  CONCLUSIONS
  Continuous femoral nerve block provides better analgesia than the continuous patellar tendon wound and intra-articular infusions after anterior cruciate ligament reconstruction with patellar tendon.
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, University Hospital of Tor Vergata, Rome, Italy. mario.dauri@fastwebnet.it
authors.forename: Mario
authors.initials: M
authors.lastname: Dauri
authors.forename: Eleonora
authors.initials: E
authors.lastname: Fabbi
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Mariani
authors.forename: Skerdilajd
authors.initials: S
authors.lastname: Faria
authors.forename: Roberta
authors.initials: R
authors.lastname: Carpenedo
authors.forename: Tatiana
authors.initials: T
authors.lastname: Sidiropoulou
authors.forename: Filadelfo
authors.initials: F
authors.lastname: Coniglione
authors.forename: Maria B
authors.initials: MB
authors.lastname: Silvi
authors.forename: Alessandro F
authors.initials: AF
authors.lastname: Sabato
mesh_terms: D000293:Adolescent; D000328:Adult; D000577:Amides; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D002408:Catheters, Indwelling; D003000:Clonidine; D005260:Female; D005267:Femoral Nerve; D006801:Humans; D007260:Infusion Pumps; D007270:Injections, Intra-Articular; D020910:Ketorolac / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D009407:Nerve Block / Q000379:methods*; D019637:Orthopedic Procedures; D010147:Pain Measurement; D017847:Patellar Ligament / Q000601:surgery; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D000077212:Ropivacaine; D012584:Sciatic Nerve; D055815:Young Adult
chemical_list: D000577:Amides; D009020:Morphine; D000077212:Ropivacaine; D003000:Clonidine; D020910:Ketorolac