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ANALGESIC EFFECT OF HAMSTRING BLOCK AFTER ANTERIOR CRUCIATE LIGAMENT (ACL) RECONSTRUCTION COMPARED WITH INTRA-ARTICULAR INJECTION OF LOCAL ANAESTHESIA: A PROSPECTIVE NON-RANDOMIZED TRIAL
ESRA Academy. Cabaton J. Sep 8, 2016; 138433; 0282 Topic: Intra - Articular Techniques
Dr. Julien Cabaton
Dr. Julien Cabaton

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Abstract
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Background and Aims:

Effective pain control is necessary for outpatient arthroscopic ACL Reconstruction to permit early discharge and improved patient satisfaction and outcome (1). Femoral nerve block can delay the discharge and is feared by surgeons (2). In this study the post operative analgesic effect of hamstring donor-site block was compared with intra articular injection of the local anesthetic (LA) agent.

(1). Le Praticien en Anesthésie-Réanimation 2016  (2). Arthroscopy 2015

Methods:

A 'BEFORE AFTER' study was performed during two periods of 3 months, including all ACL reconstructions by hamstring graft achieved by the same surgeon.
The first ARTICULAR group received intra-articular injection of 20 mL 7.5mg/ml ropivacaine. The second GRAFT group received hamstring donor-site LA with the same 20 mL of 7.5mg/ml ropivacaine, through an arthroscopic sleeve.

The patients had general anesthesia after short-acting premedication, without regional anesthesia, a PONV prevention, oral multimodal postoperative analgesia and intensive local cryotherapy. The rescue pain killer at home was tramadol.
Patients were called at Day1 afer surgery.

Results:

255 patients were included (129 BEFORE / 126 AFTER). 178 patients answered the phone call at Day1 (62%), with 79 patients in each group.

There was no statistically significant difference in the pain scores measured by VAS between the groups, neither on the need for a rescue pain killer. A statistic correlation was found (p <0.001) between tramadol use and nausea-vomiting.

Conclusions:

A donor-site block in ACL reconstruction is found to be equally effective in controlling the postoperative pain as that of an intra articular injection of the LA agent, with satisfying pain scores. 

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