Peripheral Nerve Blocks for Surgery About the Knee

Howell, Richard; Hill, Brenton; Hoffman, Christopher; Treacy, Erin; Mulcahey, Mary K.

doi:10.2106/jbjs.rvw.16.00003

Cited by 6 publications

(12 citation statements)

References 58 publications

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“…Currently, there is no consensus on optimal pain management [29]. Regional nerve blocks proximal to the knee are performed by anesthesiologists utilizing neurostimulation or ultrasound guidance to minimize direct neural damage or anesthetic toxicity [6,16]. The femoral nerve block (FNB) has been commonly used for acute post-operative anesthesia in ACLR [12,29].…”

Section: Discussionmentioning

confidence: 99%

“…Alternatively, adductor canal block (ACB) and subsartorial saphenous nerve block (SSNB) have been proposed for a sensory-only block with reduced fall risk and strength deficits [1,20]. However, these blocks generally anesthetize the saphenous nerve and may provide incomplete sensory blockade to the knee based on anatomy [10,15,16,18]. A different strategy would be to focus on the specific nerves that innervate the structures responsible for post-surgical knee pain.…”

Section: Discussionmentioning

confidence: 99%

“…In a survey of orthopedic surgeons, Herkowitz et al reported overwhelming surgeon support for the development of proven, effective, and safe ways to decrease reliance on opioids for post-operative pain management [13]. Current methods of regional anesthesia widely used in ACLR often involve more proximal nerves of the lower extremity (femoral nerve block, adductor canal block, and sciatic nerve block) [16,29]. They can be effective tools for pain control, but complications can include hematoma, local anesthetic systemic toxicity, rebound pain, and vessel or nerve damage [16].…”

Section: Introductionmentioning

confidence: 99%

“…However, there is no exact agreement on the relative contribution from each of these nerves. Anatomically, there are two main divisions of identified terminal sensory branches, often termed Bgenicular^nerves, with the anterior division innervating the anterior, medial, and lateral knee capsule, fat pad, and deeper structures [10,15,16]. We used this information to develop an anesthetic technique focused on these anterior genicular nerves.…”

Section: Introductionmentioning

confidence: 99%

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Reduced Opioid Use after Surgeon-Administered Genicular Nerve Block for Anterior Cruciate Ligament Reconstruction in Adults and Adolescents

Caldwell¹,

Selepec²

2019

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Background: Pain management after anterior cruciate ligament reconstruction (ACLR) may pose a risk of prolonged opioid use. Questions/Purposes: The purposes of this study in ACLR were to investigate the efficacy of a surgeon-administered local-regional block of specific genicular nerves on post-operative analgesia following ACLR and to quantify the outpatient opioid consumption and duration through the complete post-operative course. Methods: Prospectively, all patients undergoing primary ACLR by a single surgeon were studied over a 10-month period. Exclusion criteria consisted of history of preoperative opioid use, revision surgery, multi-ligament surgery, allergy to oral opioids, and allergy to local anesthetic. ACLR was performed using autograft or allograft patellar tendon bone (PTB) graft under general anesthesia. At the conclusion of the procedure, all patients received a local anesthetic (bupivacaine 0.25%) injection by the surgeon including a unique circumferential genicular nerve and fat pad block performed based on anatomic landmarks without use of image guidance. Post-operatively, the quantity and duration of opioid use (hydrocodone 5 mg) and pain scores were recorded for 4 months prospectively. Statistical analysis was performed to evaluate risk factors for increased opioid use. Results: A single surgeon performed 75 ACLRs.After exclusions, a total of 70 patients were enrolled and followed prospectively. None were lost to follow-up. Total opioid consumption ranged from 0 to 30 tablets. The average number of opioid tablets used over the 4-month post-operative course was 5.5 (± 6.7). After surgery, 84% of patients took between 0 and 10 tablets and 21% of patients took no opioids throughout their entire post-operative course. The average duration of consumption was 2.6 days (± 3.1). No patients were taking opioids at the 6-week or 4-month follow-up. There were no refills required. No statistically significant differences were seen in regard to graft choice of autograft PTB (n = 48) vs allograft PTB (n = 22) in total opioid consumption or duration of use. In comparing adolescent (n = 31) versus adult (n = 39), no significant difference was seen in total opioid consumption or duration of use. All patients were satisfied with the post-operative pain management protocol. Conclusion: Opioid use was unexpectedly low among patients undergoing ACLR after a surgeon-administered circumferential genicular nerve block and fat pad infiltration. With this protocol, the graft choice and patient age did not correlate with increased opioid use. These results could be useful in guiding post-operative opioid prescribing after ACLR.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Reduced Opioid Use after Surgeon-Administered Genicular Nerve Block for Anterior Cruciate Ligament Reconstruction in Adults and Adolescents

Caldwell¹,

Selepec²

2019

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

View full text Add to dashboard Cite

show abstract

“…Methods of regional anesthesia often used in ACLR include the femoral nerve block (FNB), adductor canal block (ACB), and/or sciatic nerve block. 1 These techniques target nerves proximal to the knee joint with the goal of decreasing sensation to the operative field and thus preventing postoperative pain. 1 However, these techniques can be associated with complications such as hematoma, systemic anesthetic toxicity, and vessel or nerve damage, 1 and blocks targeting the sciatic and femoral nerve indiscriminately decrease both sensation and motor function, which hinder patient mobility immediately postoperatively.…”

mentioning

confidence: 99%