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 Subscription Services, Inc., A Wiley Company
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 12 million articles from more than
10,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

Unlimited reading

Read as many articles as you need. Full articles with original layout, charts and figures. Read online, from anywhere.

Stay up to date

Keep up with your field with Personalized Recommendations and Follow Journals to get automatic updates.

Organize your research

It’s easy to organize your research with our built-in tools.

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

Monthly Plan

  • Read unlimited articles
  • Personalized recommendations
  • No expiration
  • Print 20 pages per month
  • 20% off on PDF purchases
  • Organize your research
  • Get updates on your journals and topic searches

$49/month

Start Free Trial

14-day Free Trial

Best Deal — 39% off

Annual Plan

  • All the features of the Professional Plan, but for 39% off!
  • Billed annually
  • No expiration
  • For the normal price of 10 articles elsewhere, you get one full year of unlimited access to articles.

$588

$360/year

billed annually
Start Free Trial

14-day Free Trial