Comparison of Intra-Articular Injection and Femoral Nerve Block Using a Combination of Levobupivacaine with Clonidine for Postoperative Analgesia after Arthroscopic Anterior Cruciate Ligament ReconstructionA Randomised Double-Blind Clinical Trial
Introduction: Anterior Cruciate Ligament (ACL) is the most commonly injured ligament in the knee. Arthroscopic ACL reconstruction is the gold standard procedure for treating ACL tears. Good postoperative analgesia is the secret for immediate postoperative rehabilitation. Various techniques, such...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2023-08-01
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| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://www.jcdr.net/articles/PDF/18265/64157_CE[Ra1]_F(IS)_PF1(SD_RD_IS)_PFA(KM)_PF2(AvG_KM_OM)_PB(AvG_OM)_PN(KM).pdf |
| Summary: | Introduction: Anterior Cruciate Ligament (ACL) is the most
commonly injured ligament in the knee. Arthroscopic ACL
reconstruction is the gold standard procedure for treating ACL
tears. Good postoperative analgesia is the secret for immediate
postoperative rehabilitation. Various techniques, such as
Femoral Nerve Blocks (FNB), epidural blocks, adductor canal
blocks, and Intra-Articular injections (IA), are used to manage
postoperative pain.
Aim: To compare the quality of postoperative analgesia using
a combination of levobupivacaine with clonidine via IA and
FNB in patients undergoing ACL reconstruction under spinal
anaesthesia.
Materials and Methods: This randomised, double-blinded trial
was conducted at Pondicherry Institute of Medical Sciences,
Puducherry, India, from August 2016 to May 2018. Forty
patients with American Society of Anaesthesiologists (ASA)
physical status I and II, aged between 18-60 years, undergoing
arthroscopic ACL repair under spinal anaesthesia were randomly
assigned to two groups, with 20 patients in each group. After the
surgery, patients in group 1 received FNB with 15 mL of 0.25%
levobupivacaine and 30 mcg clonidine, while patients in group
2 received IA with 15 mL of 0.25% levobupivacaine and 30 mcg
clonidine. Parameters such as the total duration of sensory block,
the need for rescue analgesia, and total analgesic consumption
within 24 hours were recorded postoperatively. The data were
analysed using Student’s unpaired t-test, Analysis of Variance
(ANOVA), Chi-square test, and Fisher’s-exact test. Statistical
analysis was performed using Statistical package for the Social
Science (SPSS) software (version 20.0 and info version 3.5.1)
for Windows, with a p-value <0.05 considered significant.
Results: The quality of postoperative analgesia, including the
total duration of block, the need for rescue analgesia, and total
analgesic consumption within 24 hours, was similar in both
groups. The total duration of block was 216±36.041 minutes for
the FNB group and 224±47.395 minutes for the intra-articular
group, with a p-value of 0.552. The time for rescue analgesia was
307±87.666 minutes for the FNB group and 305±82.00 minutes
for the intra-articular group, with a p-value of 0.963. There were
no significant differences between the groups in terms of sex,
age, weight, or ASA physical status classification.
Conclusion: The present study showed that the postoperative
analgesia following arthroscopic ACL reconstruction was
equally effective in both groups. Both combinations reduced
postoperative pain, expedited the return of postoperative
function, maintained vital parameters, and had no apparent
side-effects. However, IA may be considered as the preferred
option since it is easier to perform than a femoral block. |
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| ISSN: | 2249-782X 0973-709X |