title: Combined preoperative femoral and sciatic nerve blockade improves analgesia after anterior cruciate ligament reconstruction: a randomized controlled clinical trial.
abstract: OBJECTIVE
  To compare preoperative femoral (FNB) with combined femoral and sciatic nerve block (CFSNB) in patients undergoing arthroscopic anterior cruciate ligament (ACL) reconstruction.
  
  
  METHODS
  Prospective, randomized clinical trial.
  
  
  METHODS
  Ambulatory surgery center affiliated with an academic medical center.
  
  
  METHODS
  Sixty-eight American Society of Anesthesiology physical status I and II patients undergoing arthroscopic ACL reconstruction.
  
  
  METHODS
  Subjects randomized to the CFSNB group received combined femoral and sciatic nerve blocks preoperatively, whereas patients randomized to the FNB group only received femoral nerve block preoperatively. Both groups then received a standardized general anesthetic with a propofol induction followed by sevoflurane or desflurane maintenance. Intraoperative pain was treated with fentanyl. Pain in the postanesthesia care unit (PACU) was treated with ketorolac and opiates. Patients with significant pain despite ketorolac and opiates could receive a rescue nerve block.
  
  
  METHODS
  Our primary outcome variable was highest Numeric Rating Scale (NRS) pain score in PACU. NRS pain scores, opioid consumption, opioid adverse effects, and patient satisfaction were assessed perioperatively until postoperative day 3.
  
  
  RESULTS
  The highest PACU NRS pain score was significantly higher in the FNB group compared with the CFSNB group (7 [3-10] vs 5 [0-10], P=.002). The FNB group required significantly larger doses of opioids perioperatively (31.8 vs 19.8mg intravenous morphine equivalents, P<.001). PACU length of stay was significantly longer in the FNB group (128.2 vs 103.1minutes, P=.006). There was no significant difference in opioid consumption, pain scores, or patient satisfaction on postoperative days 1-3 between groups.
  
  
  CONCLUSIONS
  Preoperative CFSNB for arthroscopic ACL reconstruction improves analgesia, decreases opioid consumption perioperatively, and decreases PACU length of stay when compared with FNB alone.
authors.affiliation: Department of Anesthesia and Perioperative Care, University of California, San Francisco. Electronic address: Monica.Harbell@ucsf.edu.
authors.forename: Monica W
authors.initials: MW
authors.lastname: Harbell
authors.affiliation: Department of Anesthesia and Perioperative Care, University of California, San Francisco.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Cohen
authors.affiliation: Department of Anesthesia and Perioperative Care, University of California, San Francisco.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Kolodzie
authors.affiliation: Department of Anesthesia and Perioperative Care, University of California, San Francisco.
authors.forename: Matthias
authors.initials: M
authors.lastname: Behrends
authors.affiliation: Department of Anesthesia and Perioperative Care, University of California, San Francisco.
authors.forename: Matthias R
authors.initials: MR
authors.lastname: Braehler
authors.affiliation: Department of Anesthesia and Perioperative Care, University of California, San Francisco.
authors.forename: Sakura
authors.initials: S
authors.lastname: Kinjo
authors.affiliation: Department of Orthopaedic Surgery, University of California, San Francisco.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Feeley
authors.affiliation: Department of Anesthesia and Perioperative Care, University of California, San Francisco.
authors.forename: Pedram
authors.initials: P
authors.lastname: Aleshi
mesh_terms: D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000379:methods; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000768:Anesthesia, General / Q000379:methods; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D001182:Arthroscopy / Q000379:methods; D004334:Drug Administration Schedule; D005260:Female; D005267:Femoral Nerve; D006801:Humans; D008297:Male; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000517:prevention & control; D017060:Patient Satisfaction; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D012584:Sciatic Nerve; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid
keywords: Ambulatory surgical procedures; Anterior cruciate ligament; Femoral nerve; Nerve block; Sciatic nerve