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.
Anaesthesia – Wiley
Published: Jan 1, 2018
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