Summary

It had lesser early postoperative pain scores, earlier ambulation, and shorter hospital stay as compared to spinal anaesthesia.

Abstract

Purpose

Triple nerve block (femoral-obturator-sciatic) has been proven to be useful for lower limb surgeries in recent literature. However, the use of triple nerve block as a sole anaesthetic agent has not been described for arthroscopic anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to compare consciousness during the procedure, pain during the early postoperative period (< 7 days), and perioperative outcomes following ACLR using triple nerve blocks compared to spinal anaesthesia.

Methods

A prospective case-control study including patients between 18-55 years of age, with clinically and radiologically confirmed anterior cruciate ligament (ACL) injury undergoing primary ACLR. An alternative allocation was followed to divide the patients into two groups where group 1 included patients receiving triple nerve blocks, and group 2 with patients receiving spinal anaesthesia. The adequacy of anaesthesia, intraoperative and postoperative analgesic use, sensory effect, motor effect, duration of stay, postoperative pain (Visual analogue scale 0-10cm), and functional outcomes were noted.

Results

A total of 60 patients enrolled in group 1 and 60 patients in group 2 excluding 18 patients with additional procedures performed with ACLR. A total of 7 patients in group 1 (11%) and 2 patients in group 2 (3%) needed conversion to general anaesthesia (p=0.7). In group 1, out of 53 patients operated under the block, there were 26 patients had no perception of surgery in the knee, 17 patients were having a perception of manipulation, 4 patients had a sense of touch, and 6 patients had a sensation of pain in the knee (VAS scale less than 3). However, in group 2, out of 58 patients, there were 42 patients with no perception of surgery in the knee, 12 had a perception of manipulation of the knee joint, 2 had a sense of touch, and 2 had a sensation of pain in the knee. The sensory effect grading was significantly better in group 2 (p=0.0001). However, the motor effect was comparable between the two groups (0.4). The pain scores were significantly better in group 1 at 6-, 12-, and 18 hours after the surgery. Moreover, patients in group 1 also had faster ambulation (mean difference of 5.5 hours) (p=0.0001) and reduced hospital stay (mean difference of 8.4 hours) (p=0.0001).

Conclusion

Triple nerve block may be an effective sole anaesthetic modality for ACLR. Although the sensory effect was lesser than spinal anaesthesia, it was sufficient for the procedure in the majority of the patients. It had lesser early postoperative pain scores, earlier ambulation, and shorter hospital stay as compared to spinal anaesthesia.