2017 ISAKOS Biennial Congress ePoster #1009
Hamstring Donor Site Block Provides Equivalent Pain Relief io Intra-Articular Injection Following ACL Reconstruction: A Prospective Non-Randomized Trial
Adnan Saithna, MBChB, MSc, BMedSc, DipSEM, FRCS, Ormskirk UNITED KINGDOM
Abdul Azeem, MD, Lyon FRANCE
Eric Choudja, MD, Lausanne SWITZERLAND
Maxime Cavalier, MD, Lyon FRANCE
Thais Dutra Vieira, MD, Lyon FRANCE
Jean Baptiste Pic, MD, Lyon FRANCE
Julien Cabaton, MD, Lyon FRANCE
Mathieu Thaunat, MD, Lyon, Rhône FRANCE
Bertrand Sonnery-Cottet, MD, Lyon, Rhône FRANCE
Centre Orthopedique Santy, FIFA medical center of Excellence, group Ramsay-Generale de Santé, Lyon, FRANCE
FDA Status Cleared
There is no significant difference between hamstring donor site block and intra-articular local anaesthetic injection after ACL reconstruction with respect to post operative visual analogue scale (VAS) pain scores, the need for additional oral opiate analgesia, patient satisfaction or the ability to reliably demonstrate forceful isometric contraction.
Effective pain management after anterior cruciate ligament reconstruction (ACLR) requires a multimodal approach. This includes general or epidural anaesthesia combined with opiate analgesia. However, opiod analgesia is associated with side effects that can delay early mobilization e.g nausea, vomiting, dizziness and vertigo. It is therefore logical to reduce their use by employing anaesthetic techniques such as peripheral nerve blocks, intra-articular injection or hamstring donor site block. Currently, there is no consensus on the optimum analgesic regimen and further study is required to determine this. Hamstring donor site block is an increasingly popular strategy because patients often complain of donor site pain postoperatively. However, its efficacy compared to more established pain relieving modalities is not clearly defined.
The purpose of this study was to compare hamstring donor site block against intra- articular injection of local anesthetic with respect to efficacy of analgesia and satisfaction of patients undergoing ACLR.
The sample size calculation was based on the reported minimally important clinical difference (MCID 1.3) and the standard deviation (S.D. 2.5) of the Visual Analogue Scale (VAS) pain score in previous studies reporting this after ACLR. The significance level was set at 5% and the power at 90%. This determined a minimum population of 64 patients in each of the two study groups. Consecutive patients undergoing ACL reconstruction under general anaesthesia between 5th May and 5th November 2015 were included in the study. No peripheral nerve blocks were performed. Instead, 100mg Ketoprofen, 1g paracetamol and 20mg nefopam, were administered at the beginning of surgery. The first 79 patients were allocated to the intra-articular injection group while the second set of patients received hamstring donor site block. Both procedures were performed with 20 mL of 7.5mg/ml Ropivacaine. Postoperative pain was evaluated using the 10-point VAS score. Patient demographics, rates of additional procedures performed, rescue analgesics, discharge time, and patient satisfaction were recorded. Patients were telephoned the day following surgery and pain scores, side effects and satisfaction levels were recorded. Continuous variables were analysed by the Mann Whitney test. Categorical variables were compared with the Chi2 test or the Fischer’s exact test.
There was no significant difference between groups with respect to gender ratio, age, time from injury to surgery, or rates of additional procedures performed. There was no significant difference in the VAS pain scores, either in recovery (Group 1; 1.37, Group 2; 1.93, mean difference 0.56, p=0.09) or at 12 hours post-operatively (Group 1; 2.08, Group 2; 1.88, mean difference 0.2, p=0.6) between the groups. Furthermore there was no significant difference between the groups with respect to the need for additional oral opiate analgesia (tramadol) or patient satisfaction or the ability to reliably demonstrate forceful isometric contraction. There were no major post-operative complications observed in either group.
The use of a donor-site block in hamstring ACL reconstruction is as effective in controlling post-operative pain levels as an intra articular injection of local anesthetic but avoids the potential hazard of chondrotoxicity.