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Usefulness of lateral femoral cutaneous nerve block in combination with femoral nerve block for anterior cruciate ligament reconstruction: a prospective trial

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The study aimed to compare the combination of femoral nerve block (FNB) with interspace between the popliteal artery and the capsule of posterior knee (IPACK) block (IPACK group) with the combination of FNB with lateral femoral cutaneous nerve (LFCN) block (LFCN group) for postoperative pain control in patients undergoing anterior cruciate ligament (ACL) reconstruction. We hypothesized that the lower pain scores and decreased suppository use would be noted in patients administered a combination of FNB and IPACK block.

Materials and Methods

A non-randomized prospective controlled clinical trial was conducted. The IPACK and LFCN groups included 40 patients each. The patients received IPACK block and LFCN block alternately. Thirty minutes prior to the surgery and after administration of general anesthesia, patients received an ultrasound-guided FNB and IPACK block or LFCN block. After ACL reconstruction, the visual analog scale pain scores were recorded at 30 min, 4 h, 8 h, 12 h, 24 h, 48 h, and 72 h after the surgery. The administration and use of analgesic suppositories were assessed. These measures were compared among the treatment types at each time-point using the Welch’s t-test.

Results

Suppository use was significantly less in the LFCN group than in the IPACK group. The pain scores were significantly lower in the LFCN group at 30 min, 4 h, 48 h, and 72 h after the surgery.

Conclusion

The combination of FNB with LFCN block during ACL reconstruction significantly reduces pain in the early postoperative period compared to a combination of FNB with IPACK block.

Level of evidence

Prospective control trial, Level II.

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References

  1. Beck PR, Nho SJ, Balin J, Badrinath SK, Bush-Joseph CA, Bach BR Jr, Hayden JK (2004) Postoperative pain management after anterior cruciate ligament reconstruction. J Knee Surg 17:18–23

    Article  Google Scholar 

  2. Frost S, Grossfeld S, Kirkley A, Litchfield B, Fowler P, Amendola A (2000) The efficacy of femoral nerve block in pain reduction for outpatient hamstring anterior cruciate ligament reconstruction: a double-blind, prospective, randomized trial. Arthroscopy 16:243–248

    Article  CAS  Google Scholar 

  3. Kocher MS, Steadman JR, Briggs K, Zurakowski D, Sterett WI, Hawkins RJ (2002) Determinants of patient satisfaction with outcome after anterior cruciate ligament reconstruction. J Bone Joint Surg Am 84:1560–1572

    Article  Google Scholar 

  4. Edwards MD, Bethea JP, Hunnicutt JL, Slone HS, Woolf SK (2020) Effect of adductor canal block versus femoral nerve block on quadriceps strength, function, and postoperative pain after anterior cruciate ligament reconstruction: a systematic review of level 1 studies. Am J Sports Med 48:2305–2313

    Article  Google Scholar 

  5. Keller RA, Birns ME, Cady AC, Limpisvasti O, Banffy MB (2019) Posterior capsule injection of local anesthetic for post-operative pain control after ACL reconstruction: a prospective, randomized trial. Knee Surg Sports Traumatol Arthrosc 27:822–826

    Article  Google Scholar 

  6. Kirkham KR, Grape S, Martin R, Albrecht E (2017) Analgesic efficacy of local infiltration analgesia vs. femoral nerve block after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Anaesthesia 72:1542–1553

    Article  CAS  Google Scholar 

  7. Xu J, Chen XM, Ma CK, Wang XR (2014) Peripheral nerve blocks for postoperative pain after major knee surgery. Cochrane Database Syst Rev 12:CD010937

    Google Scholar 

  8. Iskandar H, Benard A, Ruel-Raymond J, Cochard G, Manaud B (2003) Femoral block provides superior analgesia compared with intraarticular ropivacaine after anterior cruciate ligament reconstruction. Reg Anesth Pain Med 28:29–32

    Article  CAS  Google Scholar 

  9. Mulroy MF, Larkin KL, Batra MS, Hodgson PS, Owens BD (2001) Femoral nerve block with 0.25% or 0.5% bupivacaine improves postoperative analgesia following outpatient arthroscopic anterior cruciate ligament repair. Reg Anesth Pain Med 26:24–29

    Article  CAS  Google Scholar 

  10. Sankineani SR, Reddy ARC, Eachempati KK, Jangale A, Gurava Reddy AV (2018) Comparison of adductor canal block and IPACK block (interspace between the popliteal artery and the capsule of the posterior knee) with adductor canal block alone after total knee arthroplasty: a prospective control trial on pain and knee function in immediate postoperative period. Eur J Orthop Surg Traumatol 28:1391–1395

    Article  CAS  Google Scholar 

  11. Thobhani S, Scalercio L, Elliott CE, Nossaman BD, Thomas LC, Yuratich D, Bland K, Osteen K, Patterson ME (2017) Novel Regional Techniques for Total Knee Arthroplasty Promote Reduced Hospital Length of Stay: an Analysis of 106 Patients. Ochsner J 17:233–238

    PubMed  PubMed Central  Google Scholar 

  12. Kampitak W, Tansatit T, Tanavalee A, Ngarmukos S (2019) Optimal location of local anesthetic injection in the interspace between the popliteal artery and posterior capsule of the knee (iPACK) for posterior knee pain after total knee arthroplasty: an anatomical and clinical study. Korean J Anesthesiol 72:486–494

    Article  Google Scholar 

  13. Nielsen TD, Moriggl B, Barckman J, Kølsen-Petersen JA, Søballe K, Børglum J, Bendtsen TF (2018) The lateral femoral cutaneous nerve: description of the sensory Territory and a Novel Ultrasound-Guided Nerve Block Technique. Reg Anesth Pain Med 43:357–366

    Article  Google Scholar 

  14. Shteynberg A, Riina LH, Glickman LT, Meringolo JN, Simpson RL (2013) Ultrasound guided lateral femoral cutaneous nerve (LFCN) block: safe and simple anesthesia for harvesting skin grafts. Burns 39:146–149

    Article  Google Scholar 

  15. Nakase J, Toratani T, Kosaka M, Ohashi Y, Numata H, Oshima T, Takata Y, Tsuchiya H (2016) Technique of anatomical single bundle ACL reconstruction with rounded rectangle femoral dilator. Knee 23:91–96

    Article  Google Scholar 

  16. Kandarian B, Indelli PF, Sinha S, Hunter OO, Wang RR, Kim TE, Kou A, Mariano ER (2019) Implementation of the IPACK (Infiltration between the Popliteal Artery and Capsule of the Knee) block into a multimodal analgesic pathway for total knee replacement. Korean J Anesthesiol 72:238–244

    Article  Google Scholar 

  17. Vilhelmsen F, Nersesjan M, Andersen JH, Danker JK, Broeng L, Hägi-Pedersen D, Mathiesen O, Thybo KH (2019) Lateral femoral cutaneous nerve block with different volumes of Ropivacaine: a randomized trial in healthy volunteers. BMC Anesthesiol 28(19):165

    Article  Google Scholar 

  18. Wiesmann T, Piechowiak K, Duderstadt S, Haupt D, Schmitt J, Eschbach D, Feldmann C, Wulf H, Zoremba M, Steinfeldt T (2016) Continuous adductor canal block versus continuous femoral nerve block after total knee arthroplasty for mobilisation capability and pain treatment: a randomised and blinded clinical trial. Arch Orthop Trauma Surg 136:397–406

    Article  Google Scholar 

  19. Harbell MW, Cohen JM, Kolodzie K, Behrends M, Braehler MR, Kinjo S, Feeley BT, Aleshi P (2016) Combined preoperative femoral and sciatic nerve blockade improves analgesia after anterior cruciate ligament reconstruction: a randomized controlled clinical trial. J Clin Anesth 33:68–74

    Article  Google Scholar 

  20. Silverman ER, Vydyanathan A, Gritsenko K, Shaparin N, Singh N, Downie SA, Kosharskyy B (2017) The anatomic relationship of the tibial nerve to the common peroneal nerve in the popliteal fossa: implications for selective tibial nerve block in total knee arthroplasty. Pain Res Manag. 7250181

  21. Raynor MC, Pietrobon R, Guller U, Higgins LD (2005) Cryotherapy after ACL reconstruction: a meta-analysis. J Knee Surg 18:123–129

    Article  Google Scholar 

  22. Senthilkumaran S, Tate R, Read JR, Sutherland AG (2010) Intra-articular morphine and bupivicaine for post-operative analgesia in anterior cruciate ligament reconstruction: a prospective randomised controlled trial. Knee Surg Sports Traumatol Arthrosc 18:731–735

    Article  CAS  Google Scholar 

  23. Williams BA, Kentor ML, Vogt MT, Vogt WB, Coley KC, Williams JP, Roberts MS, Chelly JE, Harner CD, Fu FH (2004) Economics of nerve block pain management after anterior cruciate ligament reconstruction: potential hospital cost savings via associated postanesthesia care unit bypass and same-day discharge. Anesthesiology 100:697–706

    Article  Google Scholar 

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Funding

The study did not receive grants from any funding agency in the public, private, and not-for-profit sector.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-0934, Japan

    Junsuke Nakase, Kengo Shimozaki, Kazuki Asai, Rikuto Yoshimizu, Mitsuhiro Kimura & Hiroyuki Tsuchiya

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  1. Junsuke Nakase
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  2. Kengo Shimozaki
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  3. Kazuki Asai
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  4. Rikuto Yoshimizu
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  5. Mitsuhiro Kimura
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  6. Hiroyuki Tsuchiya
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Contributions

JN prepared the most part of the submitted text (main author) and directed the submitted study and contributed to the preparation of the Discussion part (corresponding author). KS, KA, RY, and MK contributed to the discussion on the study design and the preparation of the Materials and Methods part, and Data collection. HT contributed to the discussion on the study design and the preparation of the Discussion part.

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Correspondence to Junsuke Nakase.

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Nakase, J., Shimozaki, K., Asai, K. et al. Usefulness of lateral femoral cutaneous nerve block in combination with femoral nerve block for anterior cruciate ligament reconstruction: a prospective trial. Arch Orthop Trauma Surg 141, 455–460 (2021). https://doi.org/10.1007/s00402-020-03724-9

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  • DOI: https://doi.org/10.1007/s00402-020-03724-9

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