Ultrasound-guided peripheral nerve blocks for anterior cruciate ligament reconstruction: effect of obturator nerve block during and after surgery.
OBJECTIVE
Three studies were conducted to determine whether and how the obturator nerve bears relevance to intra- and postoperative pain in patients undergoing anterior cruciate ligament (ACL) reconstruction using a hamstring autograft.


METHODS
Patients undergoing arthroscopic ACL reconstruction using a hamstring autograft were enrolled in three studies. In the first study, we studied the analgesic effect of combined posterior lumbar plexus (PLP) and sciatic nerve blocks as well as combined femoral, lateral femoral cutaneous, and sciatic nerve blocks during and for 24 h after surgery. The second study was conducted to compare the analgesic effect of the combination of femoral, lateral femoral cutaneous, and sciatic nerve blocks with and without an obturator nerve block. Finally, we compared a postoperative continuous femoral nerve block and PLP block both during and for 48 h after surgery.


RESULTS
In the first study, patients receiving the PLP block required significantly less fentanyl intraoperatively than those given the femoral nerve block. In the second, significantly less fentanyl was required during surgery for patients with the obturator nerve block than for those without. Finally, the continuous postoperative PLP block showed higher visual analog pain scores than those with the continuous femoral nerve block during movement at 48 h.


CONCLUSIONS
The present results suggest the involvement of the obturator nerve in ACL reconstruction using a hamstring autograft. However, although obturator nerve blockade is crucial for intraoperative analgesia, a continuous obturator nerve block is not necessary beyond 24 h postoperatively.
Surgical Center, University Hospital, Shimane University School of Medicine, 89-1 Enya-cho, Izumo 693-8501, Japan. ssakura@med.shimane-u.ac.jp
Shinichi
S
Sakura
Kaoru
K
Hara
Junichi
J
Ota
Saki
S
Tadenuma
D000293:Adolescent; D000328:Adult; D000368:Aged; D018686:Anesthetics, Intravenous; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D005260:Female; D005267:Femoral Nerve / Q000000981:diagnostic imaging; D005283:Fentanyl; D006801:Humans; D008022:Ligaments / Q000601:surgery; D008160:Lumbosacral Plexus / Q000000981:diagnostic imaging; D008297:Male; D008874:Midazolam; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D009776:Obturator Nerve / Q000000981:diagnostic imaging*; D010147:Pain Measurement / Q000187:drug effects; D010525:Peripheral Nerves; D019651:Plastic Surgery Procedures; D012584:Sciatic Nerve / Q000000981:diagnostic imaging; D014182:Transplantation, Autologous; D014463:Ultrasonography; D055815:Young Adult
D018686:Anesthetics, Intravenous; D008874:Midazolam; D005283:Fentanyl