Optimising analgesia for day‐case cruciate ligament reconstruction

Optimising analgesia for day‐case cruciate ligament reconstruction Kirkham et al.'s systematic review comparing local infiltration and femoral nerve block (FNB) for anterior cruciate ligament (ACL) reconstruction , reports that there is moderate evidence use of FNB is superior to local infiltration in the first 24‐h postoperative period.However, ACL reconstruction is now frequently performed as a day‐case procedure . Although regional techniques may meet the criteria of an ideal analgesic, they are associated with unwanted effects such as quadriceps weakness, resulting in delayed mobilisation . There is also a risk of inadequate analgesia in the late postoperative period (greater than 12 h), particularly in those day‐case patients who may still have a residual block at time of discharge.Mehdi et al. suggest that local infiltration combined with oral analgesia can successfully be used instead of FNB, with similar analgesic efficacy, to facilitate discharge within 24 h . Did the authors consider length of stay or number of day‐case procedures as a secondary outcome?In patients who fulfil the day‐case criteria, should we not aim for optimal analgesia over ideal analgesia (FNB) in order to allow for early mobilisation, adequate pain control and earlier discharge?ReferencesKirkham KR, Grape S, Martin R, Albrecht E. Analgesic efficacy of local infiltration analgesia vs. femoral nerve block after anterior cruciate ligament reconstruction: a systematic review and meta‐analysis. Anaesthesia 2017; 72: 1542–53.Kassam A, Schranz P, Mandalia V. Daycase anterior cruciate ligament reconstruction: success, pitfalls and patient pain scores. British Journal of Medical Practitioners 2013; 6: a632.Williams BA, Kentor ML, Vogt MT. Reduction of verbal pain scores after anterior cruciate ligament reconstruction with 2‐day continuous femoral nerve block: a randomized clinical trial. Anesthesiology 2006; 104: 315–27.Mehdi SA, Dalton DJ, Sivarajan V, Leach WJ. BTB ACL reconstruction: femoral nerve block has no advantage over intraarticular local anaesthetic infiltration. Knee Surgery, Sports Traumatology, Arthroscopy 2004; 12: 180–3. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Anaesthesia Wiley

Optimising analgesia for day‐case cruciate ligament reconstruction

Free
1 page

Loading next page...
1 Page
 
/lp/wiley/optimising-analgesia-for-day-case-cruciate-ligament-reconstruction-QBOXIcV70h
Publisher
Wiley
Copyright
Copyright © 2018 The Association of Anaesthetists of Great Britain and Ireland
ISSN
0003-2409
eISSN
1365-2044
D.O.I.
10.1111/anae.14264
Publisher site
See Article on Publisher Site

Abstract

Kirkham et al.'s systematic review comparing local infiltration and femoral nerve block (FNB) for anterior cruciate ligament (ACL) reconstruction , reports that there is moderate evidence use of FNB is superior to local infiltration in the first 24‐h postoperative period.However, ACL reconstruction is now frequently performed as a day‐case procedure . Although regional techniques may meet the criteria of an ideal analgesic, they are associated with unwanted effects such as quadriceps weakness, resulting in delayed mobilisation . There is also a risk of inadequate analgesia in the late postoperative period (greater than 12 h), particularly in those day‐case patients who may still have a residual block at time of discharge.Mehdi et al. suggest that local infiltration combined with oral analgesia can successfully be used instead of FNB, with similar analgesic efficacy, to facilitate discharge within 24 h . Did the authors consider length of stay or number of day‐case procedures as a secondary outcome?In patients who fulfil the day‐case criteria, should we not aim for optimal analgesia over ideal analgesia (FNB) in order to allow for early mobilisation, adequate pain control and earlier discharge?ReferencesKirkham KR, Grape S, Martin R, Albrecht E. Analgesic efficacy of local infiltration analgesia vs. femoral nerve block after anterior cruciate ligament reconstruction: a systematic review and meta‐analysis. Anaesthesia 2017; 72: 1542–53.Kassam A, Schranz P, Mandalia V. Daycase anterior cruciate ligament reconstruction: success, pitfalls and patient pain scores. British Journal of Medical Practitioners 2013; 6: a632.Williams BA, Kentor ML, Vogt MT. Reduction of verbal pain scores after anterior cruciate ligament reconstruction with 2‐day continuous femoral nerve block: a randomized clinical trial. Anesthesiology 2006; 104: 315–27.Mehdi SA, Dalton DJ, Sivarajan V, Leach WJ. BTB ACL reconstruction: femoral nerve block has no advantage over intraarticular local anaesthetic infiltration. Knee Surgery, Sports Traumatology, Arthroscopy 2004; 12: 180–3.

Journal

AnaesthesiaWiley

Published: Jan 1, 2018

References

You’re reading a free preview. Subscribe to read the entire article.


DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 18 million articles from more than
15,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

Search

Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly

Organize

Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place.

Access

Get unlimited, online access to over 18 million full-text articles from more than 15,000 scientific journals.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

DeepDyve

Freelancer

DeepDyve

Pro

Price

FREE

$49/month
$360/year

Save searches from
Google Scholar,
PubMed

Create lists to
organize your research

Export lists, citations

Read DeepDyve articles

Abstract access only

Unlimited access to over
18 million full-text articles

Print

20 pages / month

PDF Discount

20% off