Anesthesia & Clinical Research
Open Access

Abstract

Preoperative Sciatic and Femoral Nerve Blocks for Anterior Cruciate Ligament Reconstruction: A Retrospective Analysis

Joshua M Cohen, Kerstin Kolodzie, Sujay Shah and Pedram Aleshi

Objective: Uncontrolled postoperative pain and nausea and vomiting are the most common causes for hospital admission following ambulatory anterior cruciate ligament (ACL) reconstruction. Therefore, finding techniques that provide excellent postoperative pain control is of critical importance. This retrospective study compared patients who received preoperative femoral nerve blockade to those who received combined femoral and sciatic nerve blockade. We hypothesized that a combined preoperative nerve block would result in lower postoperative pain, decreased postoperative opioid consumption, and shorter recovery.

Methods: The medical records of 191 patients who underwent ACL reconstruction were retrospectively analyzed. We then developed multivariable regression models for each primary outcome parameter.

Results: The postoperative pain scores were lower in patients receiving a combined nerve block compared with patients receiving a femoral nerve block (P<0.001) and higher in patients receiving an autograft vs. an allograft (P=0.009). Total morphine equivalents were lower in patients receiving combined nerve block versus patients receiving femoral nerve block (P<0.001) and higher in patients with a higher BMI (P<0.001). Recovery unit length of stay was prolonged by more than 25 minutes in patients with PONV (P=0.001) and in patients who needed a postoperative nerve block in the recovery unit (P ≤ 0.001).

Conclusions: A preoperative combined sciatic and femoral nerve block improved postoperative pain management, while postoperative nausea and vomiting or the need for a postoperative nerve block increased the recovery unit time.