title: A prospective double blinded randomized study of anterior cruciate ligament reconstruction with hamstrings tendon and spinal anesthesia with or without femoral nerve block.
abstract: BACKGROUND
  Current literature supports the thought that anesthesia and analgesia administered perioperatively for an anterior cruciate ligament (ACL) reconstruction have a great influence on time to effective rehabilitation during the first week after hospital discharge.
  
  
  OBJECTIVE
  The aim of this study is to answer the research question is there a difference in clinical outcomes between the use of a femoral nerve block with spinal anesthesia versus spinal analgesia alone for people undergoing ACL reconstruction?
  
  
  METHODS
  ACL reconstruction with spinal anesthesia and patient sedation (Group one); and spinal anesthesia with patient sedation and an additional femoral nerve block (Group two). Patients were re-evaluated for pain, range of motion (ROM), active contraction of the quadriceps, and a Functional Independence Measure (FIM) scoring scale.
  
  
  RESULTS
  Spinal anesthesia with a femoral nerve block demonstrates pain relief 6h after surgery (VAS 0.37; p=0.007). From the third (VAS=4.56; p=0.028) to the seventh (VAS=2.87; p=0.05) days after surgery, this same nerve blockage delivered higher pain scores. Patients had a similar progressive improvement on knee joint range of motion with or without femoral nerve block (p<0.002). Group one and two had 23.75 and 24.29° 6h after surgery and 87.81 and 85.36° of knee flexion after 48h post op.
  
  
  CONCLUSIONS
  Spinal anesthesia associated with a femoral nerve block had no additional benefits on pain control after the third postoperative day. There were no differences between groups concerning ability for knee flexion and to complete daily activities during postoperative period.
  
  
  METHODS
  Randomized Clinical Trial Level I.
authors.affiliation: Orthopaedics and Traumatology Department, Escola Paulista de Medicina/UNIFESP, São Paulo, SP, Brazil. Electronic address: mcastur@yahoo.com.
authors.forename: Diego Costa
authors.initials: DC
authors.lastname: Astur
authors.affiliation: Instituto Cohen, São Paulo, SP, Brazil. Electronic address: vicoaleluia@superig.com.br.
authors.forename: Vinicius
authors.initials: V
authors.lastname: Aleluia
authors.affiliation: Instituto Cohen, São Paulo, SP, Brazil. Electronic address: ciroveronese@yahoo.com.
authors.forename: Ciro
authors.initials: C
authors.lastname: Veronese
authors.affiliation: The University of Tennessee, Memphis, TN, USA. Electronic address: nelsonan@yahoo.com.
authors.forename: Nelson
authors.initials: N
authors.lastname: Astur
authors.affiliation: Instituto Cohen, São Paulo, SP, Brazil. Electronic address: Saulo.goliveira@hotmail.com.
authors.forename: Saulo Gomes
authors.initials: SG
authors.lastname: Oliveira
authors.affiliation: Orthopaedics and Traumatology Department, Escola Paulista de Medicina/UNIFESP, São Paulo, SP, Brazil. Electronic address: ggarliani@hotmail.com.
authors.forename: Gustavo Gonçalves
authors.initials: GG
authors.lastname: Arliani
authors.affiliation: Instituto Cohen, São Paulo, SP, Brazil. Electronic address: r_badra@hotmail.com.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Badra
authors.affiliation: Santa Casa School of Medicine and Hospitals, São Paulo, SP, Brazil. Electronic address: camilacohen@kaleka.com.br.
authors.forename: Camila Cohen
authors.initials: CC
authors.lastname: Kaleka
authors.affiliation: Instituto Cohen, São Paulo, SP, Brazil. Electronic address: joicemar@uol.com.br.
authors.forename: Joicemar Tarouco
authors.initials: JT
authors.lastname: Amaro
authors.affiliation: Orthopaedics and Traumatology Department, Escola Paulista de Medicina/UNIFESP, São Paulo, SP, Brazil. Electronic address: m.cohen@uol.com.br.
authors.forename: Moisés
authors.initials: M
authors.lastname: Cohen
mesh_terms: D000293:Adolescent; D000328:Adult; D000577:Amides / Q000008:administration & dosage; D000775:Anesthesia, Spinal; D000779:Anesthetics, Local / Q000008:administration & dosage; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000009:adverse effects*; D002045:Bupivacaine / Q000008:administration & dosage; D004311:Double-Blind Method; D005260:Female; D005267:Femoral Nerve; D006801:Humans; D007718:Knee Injuries / Q000601:surgery*; D008297:Male; D009407:Nerve Block; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D016059:Range of Motion, Articular; D020127:Recovery of Function; D000077212:Ropivacaine; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D002045:Bupivacaine
keywords: ACL reconstruction; Anesthesia; Femoral nerve block; Knee; Randomized clinical trial