Efficacy of the Adductor Canal Approach to Saphenous Nerve Block for Anterior Cruciate Ligament Reconstruction With Hamstring Autograft: A Randomized Controlled Trial

• Published in: Orthopaedic journal of sports medicine Vol. 6; no. 10; p. 2325967118800948
• Main Authors: Kejriwal, Ritwik, Cooper, Jeremy, Legg, Andrew, Stanley, Jeremy, Rosenfeldt, Michael P., Walsh, Stewart J.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.10.2018; Sage Publications Ltd
• Subjects: Clinical trials; Knee; Orthopedics; Sports medicine; hamstring autograft; saphenous nerve block; ACL reconstruction; perioperative analgesia; adductor canal block
• ISSN: 2325-9671; 2325-9671
• DOI: 10.1177/2325967118800948

Background: For reconstruction of the anterior cruciate ligament (ACL) with hamstring autograft, perioperative analgesia can be achieved with multimodal analgesia and intra-articular local anesthesia infiltration with or without additional regional blocks. Saphenous nerve block (SNB) via the adductor canal is commonly used in our practice, but its benefit has not been well established in the literature. Purpose: To assess the efficacy of SNB in ACL reconstruction with hamstring autograft. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Consecutive patients undergoing arthroscopic ACL reconstruction with hamstring autograft were randomized into a control group (no SNB) and an intervention group (SNB). All patients received standardized anesthetic induction and maintenance agents with perioperative analgesia, per study protocol, with local anesthetic infiltration of the graft harvest site and intra-articular infiltration. Results: Sixty patients were randomized into the 2 groups (n = 30 each). There was no statistically significant difference in total opiate consumption between the groups (control, 34 mg; SNB, 31 mg; P = .40). There was no statistically significant difference in visual analog scale scores for pain at 0, 8, and 24 hours postsurgery, and no difference in overall satisfaction score. The control group had a significantly higher visual analog scale score at 4 hours postsurgery (3.0 vs 1.9, P = .04). Conclusion: SNB has a minimal effect on postsurgical care for ACL reconstruction with hamstring autograft in the presence of multimodal analgesia and local anesthetic infiltration.