title: Perineural dexamethasone with subsartorial saphenous nerve blocks in ACL reconstruction.
abstract: OBJECTIVE
  Subsartorial saphenous nerve blockade (SSNB) is an effective analgesic alternative to femoral nerve blockade after anterior cruciate ligament (ACL) reconstruction with bone-tendon-bone (BTB) autograft. It was hypothesized that dexamethasone in a SSNB will prolong analgesia, improve pain and satisfaction, and reduce postoperative opioid requirements and side effects.
  
  
  METHODS
  One hundred ninety-five patients undergoing ACL reconstruction with BTB autograft (ages 16-65) were enrolled. Subjects received SSNB with 13 ml of 0.5 % bupivacaine (control group), 1 mg preservative-free dexamethasone +0.5 % bupivacaine (treatment group I), or 4 mg preservative-free dexamethasone +0.5 % bupivacaine (treatment group II). Subjects received identical perioperative management. On postoperative days 1 and 2, subjects reported perceived block duration, pain scores, satisfaction, opioid use, and side effects. Cox-proportional hazards modelling was used to compare block duration, adjusting for body mass index, age, sex, tourniquet time, American Society of Anesthesiologists classification, and intravenous dexamethasone dose.
  
  
  RESULTS
  Patient-perceived block duration was significantly increased in treatment group I [hazard ratio (95 % confidence interval [CI]) 0.48 (0.31-0.75); P = 0.001] and treatment group II (hazard ratio (95 % CI): 0.52 (0.33-0.81); P = 0.004) compared to control. The block was extended from a median (95 % CI) of 33.1 (28.4-37.3) to 41.2 (32.4-50.9) and 46.5 (35.8-48.9) hours, respectively. Additionally, patients in treatment group II reported increased time that block provided pain relief, higher patient satisfaction, lower pain scores at rest, and decreased drowsiness and confusion.
  
  
  CONCLUSIONS
  The addition of 1 and 4 mg of dexamethasone to the block injectate significantly increased SSNB duration by 8-13 h compared to control.
  
  
  METHODS
  Therapeutic study, level 1.
authors.affiliation: Department of Anesthesiology, Hospital for Special Surgery, New York, NY, USA. ChisholmM@hss.edu.
authors.forename: Mary F
authors.initials: MF
authors.lastname: Chisholm
authors.affiliation: Department of Anesthesiology, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Cheng
authors.affiliation: Healthcare Research Institute, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Kara G
authors.initials: KG
authors.lastname: Fields
authors.affiliation: Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Marx
authors.affiliation: Department of Anesthesiology, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Maalouf
authors.affiliation: Department of Anesthesiology, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Liguori
authors.affiliation: Department of Anesthesiology, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gordon
authors.affiliation: Department of Anesthesiology, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Victor M
authors.initials: VM
authors.lastname: Zayas
authors.affiliation: Department of Anesthesiology, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Jacques T
authors.initials: JT
authors.lastname: Yadeau
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage; D050376:Bone-Patellar Tendon-Bone Grafting / Q000009:adverse effects*; D002045:Bupivacaine / Q000008:administration & dosage; D003907:Dexamethasone / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D017060:Patient Satisfaction; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D003907:Dexamethasone; D002045:Bupivacaine
keywords: ACL reconstruction; Patellar tendon autograft; Postoperative pain; Subsartorial saphenous nerve block