Superior perioperative analgesia with combined femoral-obturator-sciatic nerve block in comparison with posterior lumbar plexus and sciatic nerve block for ACL reconstructive surgery.
OBJECTIVE
The purpose of this randomized controlled study is to compare and evaluate the intraoperative and post-operative outcome of PLPS nerve block and that of femoral, obturator and sciatic (FOS) nerve block as a method of anaesthesia, in performing ACL reconstruction.


METHODS
Patients referred for elective arthroscopic ACL reconstruction using hamstring autograft were divided in two groups. The first group received combined femoral-obturator-sciatic nerve block (FOS Group) under dual guidance, whereas the second group received posterior lumbar plexus block under neurostimulation and sciatic nerve block (PLPS Group) under dual guidance.


RESULTS
The two groups were comparable in terms of age, sex, BMI and athletic activity. The time needed to perform the nerve blocks was significantly shorter for the FOS group (p < 0.005). Similarly, VAS scores during tourniquet inflation and autograft harvesting were significantly higher (p < 0.005) in the PLPS group and this is also reflected in the intraoperative fentanyl consumption and conversion to general anaesthesia. Finally, patients in this group also reported higher post-operative VAS scores and consumed more morphine.


CONCLUSIONS
Peripheral nerve blockade of FOS nerve block under dual guidance for arthroscopic ACL reconstructive surgery is a safe and tempting anaesthetic choice. The success rate of this technique is higher in comparison with PLPS and results in less peri- and post-operative pain with less opioid consumption. This study provides support for the use of peripheral nerve blocks as an exclusive method for ACL reconstructive surgery in an ambulatory setting with almost no complications.


METHODS
I.
Department of Anesthesiology, Faculty of Medicine, University Hospital of Larissa, 41110, Mezourlo, Larissa, Greece. barekametaxia@hotmail.com.
Metaxia
http://orcid.org/0000-0002-1392-0135
M
Bareka
Department of Orthopaedics, Faculty of Medicine, University Hospital of Larissa, 41110, Mezourlo, Larissa, Greece.
Michael
M
Hantes
Department of Anesthesiology, Faculty of Medicine, University Hospital of Larissa, 41110, Mezourlo, Larissa, Greece.
Eleni
E
Arnaoutoglou
Department of Anesthesiology, Faculty of Medicine, University Hospital of Larissa, 41110, Mezourlo, Larissa, Greece.
George
G
Vretzakis
D000293:Adolescent; D000328:Adult; D000698:Analgesia; D059549:Anterior Cruciate Ligament Reconstruction; D001182:Arthroscopy; D004558:Electric Stimulation; D005260:Female; D005267:Femoral Nerve; D006801:Humans; D007432:Intraoperative Period; D008160:Lumbosacral Plexus; D008297:Male; D009407:Nerve Block / Q000379:methods*; D009776:Obturator Nerve; D010147:Pain Measurement; D010149:Postoperative Pain / Q000628:therapy*; D012584:Sciatic Nerve; D018084:Ultrasonography, Interventional; D055815:Young Adult
Anterior cruciate ligament; Obturator nerve block; Posterior lumbar plexus nerve block