Combined Femoral-Sciatic Nerve Block is Superior to Continuous Femoral Nerve Block During Anterior Cruciate Ligament Reconstruction in the Pediatric Population.
Background
Despite advancements in minimally invasive arthroscopic surgical techniques, post-operative pain management following ACL reconstruction remains a concern. This study compares the effectiveness of two common intraoperative pain management strategies - a femoral nerve catheter (FC) versus a combined femoral nerve catheter and single injection sciatic nerve block (FSB) - in pediatric patients undergoing ACL reconstruction.


Methods
The medical records of patients age 8 to 18 who underwent ACL reconstruction at our institution were reviewed retrospectively. All subjects underwent general anesthesia with either FC or FSB. Multivariable linear regression, or modified Poisson regression were used to compare outcome variables across groups. Propensity scores were used to minimize bias due to the non-randomized allocation of the regional anesthesia protocol.


Results
The study population included 18 subjects in the FC group and 32 subjects in the FSB group. There was no difference in incidence of nausea or opioid prescription refill requests between groups. Total intravenous (IV) morphine equivalent dose, maximum numerical rating scale (NRS) pain score, and percentage of subjects requiring one or more opioid doses in the PACU were significantly greater in the FC group relative to the FSB group. PACU length of stay (LOS) was also significantly greater in the FC group than the FSB group.


Conclusion
This study suggests that FSB may be a more effective pain management technique for reducing the total IV morphine equivalent dose, maximum NRS pain scores, number of PACU postoperative opioid doses, and PACU LOS following ACL reconstruction in the pediatric population.Level of Evidence: III.
['Daoud|Ariel Kiyomi|AK|', 'Mandler|Tessa|T|', 'Gagliardi|Alexia Georgia|AG|', 'Parikh|Harin Bhavin|HB|', 'Carry|Patrick M|PM|', 'Ice|Anusara Carolyn|AC|', 'Albright|Jay|J|']
D000293:Adolescent D059549:Anterior Cruciate Ligament Reconstruction D002648:Child D005260:Female D005267:Femoral Nerve D006801:Humans D008297:Male D009407:Nerve Block D012189:Retrospective Studies D012584:Sciatic Nerve D016896:Treatment Outcome
anterior cruciate ligament reconstruction post-operative pain management regional anesthesia