الفهرس 
Pain anatomy and physiologyOnly 14 pages are availabe for public view
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Abstract
Anterior Cruciate Ligament (ACL) is the most commonly injured ligament of the knee. Arthroscopic ACL repair (ACLR) is the technique of choice for surgery. Although arthroscopic procedures are minimally invasive surgeries, postoperative pain persists from graft anchoring into the ACL. Various modalities are used for analgesia by systemic and multiple non-systemic approaches such as local anesthetic infiltration, peripheral nerve block, intra-articular injection, and neuraxial blockade.
Despite the success and relative frequency of ACLR surgery, optimal and widely accepted approaches and regimens for controlling perioperative pain are not well established. Multimodal and pre-emptive analgesia protocols for knee surgeries have been effective in decreasing requirements for narcotic medications in the early postoperative period. The convenience of reducing the dose of intravenous narcotics lies in the fact that they are associated with a number of adverse effects such as nausea, vomiting, hypotension, respiratory depression, and constipation, which in turn can slow down rehabilitation.
Femoral nerve block (FNB) is commonly used in patients undergoing knee surgery. However, femoral nerve block causes weakness of quadriceps muscle, early ambulation is impaired and may increase the risk of falls.
Adductor canal block (ACB) blocks the saphenous nerve which is a purely sensory nerve and the nerve to vastus medialis in the adductor canal, and with ultrasonography, drug spread around the femoral artery can be visualized on the ultrasound machine with increased success rate.
This study aimed to compare adductor canal block and femoral nerve block for post-operative enhanced recovery in arthroscopic ACL repair.
This randomized open label trial included 80 healthy patients of 19 years old or older, both sexes, ASA physical status I or II scheduled for knee surgery with spinal anesthesia. Patients were randomized into two equal groups: group A: received US guided ACB with bupivacaine 0.125% in total volume of 20 ml.
group B: received US guided FNB with bupivacaine 0.125 in total volume of 20
ml.
Summary of results
• Demographic data and duration of surgery were insignificantly different
between both groups.
• Hospital stay was significantly lower in group A than in group B (P value
< 0.001).
• VAS score measurements at PACU, 16h, 20h, and 24h were insignificantly
different between both groups and were significantly lower at 4h, 8h, and
12h in group A than in group B (P value <0.05).
• Time to first analgesic request was significantly prolonged in group A than
in group B (P value <0.001). Total morphine consumption was
significantly lower in group A than in group B (P value < 0.001).
• The postoperative heart rate measurements at baseline, PACU, 30 min, 60
min, 90 min, 2h, 2.5h, 3h, 3.5h, 12.5h, 13h, 13.5h, 14h, 14.5h, 15h, 15.5h,
16h, 16.5h, 17h, 17.5h, 18h, 18.5h, 19h, 19.5h, 20h, 20.5h, 21h, 21.5h, 22h,
22.5h, 23h, 23.5h and 24h were insignificantly different between both
groups (P value >0.05) and were significantly lower at 4h, 4.5h, 5h, 5.5h,
6h, 6.5h, 7h, 7.5h, 8h, 8.5h, 9h, 9.5h, 10h, 10.5h, 11h, 11.5h and 12h in
group A than group B (P value <0.05).
• The postoperative mean arterial blood pressure measurements at baseline,
PACU, 30 min, 60 min, 90 min, 2h, 2.5h, 3h, 3.5h, 12.5h, 13h, 13.5h, 14h,
14.5h, 15h, 15.5h, 16h, 16.5h, 17h, 17.5h, 18h, 18.5h, 19h, 19.5h, 20h,
20.5h, 21h, 21.5h, 22h, 22.5h, 23h, 23.5h and 24h were insignificantly
different between both groups (P value >0.05) and were significantly lower
at 4h, 4.5h, 5h, 5.5h, 6h, 6.5h, 7h, 7.5h, 8h, 8.5h, 9h, 9.5h, 10h, 10.5h, 11h,11.5h and 12h in group A than group B (P value <0.05).