title: Analgesic effect of hamstring block after anterior cruciate ligament reconstruction compared with placebo: a prospective randomized trial.
abstract: OBJECTIVE
  To evaluate the effect of a hamstring block for postoperative pain management using 20 mL of 0.25% bupivacaine compared with placebo after anterior cruciate ligament (ACL) reconstruction with a hamstring autograft.
  
  
  METHODS
  In a 3-month period, 45 patients undergoing ACL reconstruction with a hamstring autograft who all received a femoral nerve block were randomized to receive either 20 mL of 0.25% bupivacaine or 20 mL of saline water administered through a catheter into the donor-site space. The patients and recovery staff were blinded to the treatment. Postoperative donor-site pain was evaluated subjectively by the patients using a pain score (Likert scale from 0 to 10). The pain was registered for each hour in the first 6 hours and thereafter once daily for 8 days. Furthermore, the requirement for postoperative analgesic medicine was registered.
  
  
  RESULTS
  The hamstring block group (n = 23) had significantly less pain for each of the first 6 postoperative hours. The pain score was reduced from 4.2 to 2.3 (95% confidence interval, 1.3 to 3.3) (P = .01) in the first hour and from 2.8 to 1.3 (95% confidence interval, 0.6 to 1.9) in the sixth hour, and there was a significantly lower overall requirement for early postoperative fentanyl, reduced from a mean of 58 to 35 μg (P = .02), and morphine, reduced from a mean of 10 to 6 mg (P = .04). After 6 hours, there was no difference in the pain level and use of analgesics between the 2 groups.
  
  
  CONCLUSIONS
  With the use of a donor-site block in hamstring ACL reconstruction, the donor-site pain level, as well as the overall requirement for fentanyl and morphine, was significantly reduced in the first 6 postoperative hours. No effect of the donor-site block was seen after 6 hours.
  
  
  METHODS
  Level I, therapeutic, randomized controlled study.
authors.affiliation: Department of Sports Traumatology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: petefaun@rm.dk.
authors.forename: Peter
authors.initials: P
authors.lastname: Faunø
authors.affiliation: Department of Sports Traumatology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Bent
authors.initials: B
authors.lastname: Lund
authors.affiliation: Department of Sports Traumatology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Svend Erik
authors.initials: SE
authors.lastname: Christiansen
authors.affiliation: Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Ole
authors.initials: O
authors.lastname: Gjøderum
authors.affiliation: Department of Sports Traumatology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Martin
authors.initials: M
authors.lastname: Lind
mesh_terms: D000328:Adult; D000700:Analgesics / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D016118:Anterior Cruciate Ligament / Q000601:surgery; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D002045:Bupivacaine / Q000008:administration & dosage; D004311:Double-Blind Method; D005260:Female; D005267:Femoral Nerve; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D018482:Muscle, Skeletal / Q000637:transplantation*; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000628:therapy*; D011446:Prospective Studies; D060053:Transplant Donor Site / Q000294:innervation*; D055815:Young Adult
chemical_list: D000700:Analgesics; D000779:Anesthetics, Local; D009020:Morphine; D005283:Fentanyl; D002045:Bupivacaine