Bloqueio 3-em-1 prolongado versus analgesia sistêmica no tratamento da dor pós-operatória após a reconstrução do ligamento cruzado anterior do joelho

Contreras-Domínguez, Víctor; Carbonell-Bellolio, Paulina; Ojeda-Greciet, Álvaro C.; Sanzana, Edgardo S.

doi:10.1590/s0034-70942007000300006

Cited by 5 publications

(17 citation statements)

References 24 publications

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“…The full details of the regional anaesthetic techniques are shown in online Supporting Information (Appendix S3). Briefly, ultrasound guidance alone was used by 14 studies [69, 70, 75, 83, 84, 89, 92, 95, 101, 102, 108, 110, 112, 116], nerve stimulation alone in 18 studies [81, 85, 87, 90, 93, 96, 97, 103, 105, 106, 111, 114, 115, 120, 121, 123, 124, 129] or either ultrasound and/or nerve stimulation guidance in eight studies [71, 72, 77, 78, 82, 91, 109, 113]. One study [104] did not specify nerve localisation technique.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 25 studies (1749 patients) [69, 70, 77–83, 85, 90–94, 96, 101, 111, 115, 116, 118, 120–123] reported postoperative opioid related complications. Across the included studies, there were a total of 27 pairwise comparisons and eight regional anaesthetic techniques investigated: single‐injection FNB; single‐injection ACB; single‐injection LIA; single‐injection FNB combined with single‐injection SNB; single‐injection FNB combined with single‐injection LIA; continuous FNB; continuous FNB combined with single‐injection LIA; and control (systemic analgesia) (online Supporting Information, Appendix S17).…”

Section: Resultsmentioning

confidence: 99%

“…A total of 28 studies (1611) [69, 73–75, 78, 80, 81, 83, 85, 87, 90–93, 96, 99–101, 103, 105, 106, 109, 110, 115, 121, 122, 129] assessed block‐ or infiltration‐related complications. Overall, nerve block related complications were reported for 15/420 patients after single‐injection FNB, 2/48 patients after single‐injection FNB combined with single‐injection SNB and 1/92 patients after single‐injection FNB combined with single‐injection LIA.…”

Section: Resultsmentioning

confidence: 99%

“…Of these, 34 were excluded due to their lack of randomised nature or being a crossover design (n = 2) [35, 36]; having an ineligible surgery or not having data for the ACL subgroup (n = 5) [37–41]; not having an active comparator group (n = 2) [42, 43]; or being the only study identified evaluating the specific comparison (n = 25) [44–68]. Subsequently, a total of 61 [69–129] full text randomised trials were considered for inclusion; however, after additional review, four [125–128] were excluded due to evaluating a technique that was not attached to any of the other nodes in the network. Thus, a total of 57 [69–124, 129] full‐text randomised trials were included in the systematic review and network meta‐analysis.…”

Section: Resultsmentioning

confidence: 99%

“…It is curious to note that continuous FNB, when performed alone, provided relatively poor early postoperative analgesia, but its analgesic efficacy improved considerably at 24 h. This counter‐intuitive observation likely reflects the fact that most studies included in our analysis either performed continuous FNB or delayed administration of local anaesthetics via the catheter until after surgery in the PACU [78, 103, 114, 123]. Despite good analgesia extending late into the postoperative period, continuous FNB was found to have a very low probability of preserving knee function in the postoperative period.…”

Section: Discussionmentioning

confidence: 98%

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Network meta‐analysis of the analgesic effectiveness of regional anaesthesia techniques for anterior cruciate ligament reconstruction

et al. 2022

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Summary Anterior cruciate ligament reconstruction can cause moderate to severe acute postoperative pain. Despite advances in our understanding of knee innervation, consensus regarding the most effective regional anaesthesia techniques for this surgical population is lacking. This network meta‐analysis compared effectiveness of regional anaesthesia techniques used to provide analgesia for anterior cruciate ligament reconstruction. Randomised trials examining regional anaesthesia techniques for analgesia following anterior cruciate ligament reconstruction were sought. The primary outcome was opioid consumption during the first 24 h postoperatively. Secondary outcomes were: rest pain at 0, 6, 12 and 24 h; area under the curve of pain over 24 h; and opioid‐related adverse effects and functional recovery. Network meta‐analysis was conducted using a frequentist approach. A total of 57 trials (4069 patients) investigating femoral nerve block, sciatic nerve block, adductor canal block, local anaesthetic infiltration, graft‐donor site infiltration and systemic analgesia alone (control) were included. For opioid consumption, all regional anaesthesia techniques were superior to systemic analgesia alone, but differences between regional techniques were not significant. Single‐injection femoral nerve block combined with sciatic nerve block had the highest p value probability for reducing postoperative opioid consumption and area under the curve for pain severity over 24 h (78% and 90%, respectively). Continuous femoral nerve block had the highest probability (87%) of reducing opioid‐related adverse effects, while local infiltration analgesia had the highest probability (88%) of optimising functional recovery. In contrast, systemic analgesia, local infiltration analgesia and adductor canal block were each poor performers across all analgesic outcomes. Regional anaesthesia techniques that target both the femoral and sciatic nerve distributions, namely a combination of single‐injection nerve blocks, provide the most consistent analgesic benefits for anterior cruciate ligament reconstruction compared with all other techniques but will most likely impair postoperative function. Importantly, adductor canal block, local infiltration analgesia and systemic analgesia alone each perform poorly for acute pain management following anterior cruciate ligament reconstruction.

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