[Extended three-in-one block versus intravenous analgesia for postoperative pain management after reconstruction of anterior cruciate ligament of the knee.].
OBJECTIVE
Continuous femoral block (three-in-one) is used for postoperative analgesia in hip and knee replacements with good results, with advantages over other locoregional analgesic or intravenous techniques having low incidence of complications. The aim of this study was to clinically evaluate the utility of continuous femoral block compared with intravenous analgesia in reconstruction of anterior cruciate ligament.


METHODS
Controlled prospective study of 60 patients ASA I. Patients were divided into two groups: Group 1 (n = 30): continuous femoral block with an infusion of bupivacaine and clonidine; and Group 2 (n = 30): intravenous ketoprofen infusion. Surgery was performed under spinal anesthesia and sedation. Postoperative pain management with morphine patient controlled analgesia (PCA). Postoperative pain recorded at 2, 4, 6, 24 and 36 hours after surgery using Visual Analog Scale (VAS). Morphine consumption, satisfaction's score and complications are registered.


RESULTS
In Group 1 postoperative VAS between 4 and 48 hours was 21 mm +/- 2 and in Group 2 was 45 mm +/- 4 (p < 0.001). Morphine consumption between 4 and 48 hours in Group 1 was 4.5 mg +/- 1.5 and in Group 2 was 25.5 mg +/- 3 (p < 0.001). In Group 1, 6.7% of patients presented postoperative nausea or vomiting (PONV) compared to 20% in Group 2.


CONCLUSIONS
The three-in-one block with bupivacaine and clonidine in continuous infusion provides more efficient analgesia, patient satisfaction and less consumption of intravenous morphine and PONV than intravenous analgesia.
Contreras-Domínguez
Víctor A
VA
Facultad de Medicina, Universidad de Concepción.
Carbonell-Bellolio
Paulina E
PE
Ojeda-Greciet
Alvaro C
AC
Sanzana
Edgardo S
ES