• Knee Surg Sports Traumatol Arthrosc · Apr 2017

    Perineural dexamethasone with subsartorial saphenous nerve blocks in ACL reconstruction.

    • Mary F Chisholm, Jennifer Cheng, Kara G Fields, Robert G Marx, Daniel B Maalouf, Gregory A Liguori, Michael A Gordon, Victor M Zayas, and Jacques T Yadeau.
    • Department of Anesthesiology, Hospital for Special Surgery, New York, NY, USA. ChisholmM@hss.edu.
    • Knee Surg Sports Traumatol Arthrosc. 2017 Apr 1; 25 (4): 1298-1306.

    PurposeSubsartorial saphenous nerve blockade (SSNB) is an effective analgesic alternative to femoral nerve blockade after anterior cruciate ligament (ACL) reconstruction with bone-tendon-bone (BTB) autograft. It was hypothesized that dexamethasone in a SSNB will prolong analgesia, improve pain and satisfaction, and reduce postoperative opioid requirements and side effects.MethodsOne hundred ninety-five patients undergoing ACL reconstruction with BTB autograft (ages 16-65) were enrolled. Subjects received SSNB with 13 ml of 0.5 % bupivacaine (control group), 1 mg preservative-free dexamethasone +0.5 % bupivacaine (treatment group I), or 4 mg preservative-free dexamethasone +0.5 % bupivacaine (treatment group II). Subjects received identical perioperative management. On postoperative days 1 and 2, subjects reported perceived block duration, pain scores, satisfaction, opioid use, and side effects. Cox-proportional hazards modelling was used to compare block duration, adjusting for body mass index, age, sex, tourniquet time, American Society of Anesthesiologists classification, and intravenous dexamethasone dose.ResultsPatient-perceived block duration was significantly increased in treatment group I [hazard ratio (95 % confidence interval [CI]) 0.48 (0.31-0.75); P = 0.001] and treatment group II (hazard ratio (95 % CI): 0.52 (0.33-0.81); P = 0.004) compared to control. The block was extended from a median (95 % CI) of 33.1 (28.4-37.3) to 41.2 (32.4-50.9) and 46.5 (35.8-48.9) hours, respectively. Additionally, patients in treatment group II reported increased time that block provided pain relief, higher patient satisfaction, lower pain scores at rest, and decreased drowsiness and confusion.ConclusionThe addition of 1 and 4 mg of dexamethasone to the block injectate significantly increased SSNB duration by 8-13 h compared to control.Level Of EvidenceTherapeutic study, level 1.

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