the Role of Popliteal Plexus Block in Pain Management After Anterior Cruciate Ligament Reconstruction.

• Status: Recruiting
• Trial end date: 2022-01-01
• Target enrollment: 0
• Participant gender: All

Summary

Anterior cruciate ligament (ACL) injury is traumatic and debilitating and is typically repaired using an arthroscopic technique performed as an outpatient surgical procedure. However, many patients complain that the postoperative pain is severe for the first 48 hours following the ACL reconstruction .

Effective postoperative pain management is a critical component to recovery, effective rehabilitation and patient satisfaction. Following ACL reconstruction, psychological factors are predictive of outcomes, and pain levels are inversely associated with function and quality of life assessment.

ACL reconstruction procedures may reflect the complexity innervation of the anatomical areas involved, which includes the femoral nerve and its infrapatellar and saphenous branches, the obturator nerve, as well as the tibial and common peroneal branches of the sciatic nerve. Therefore, surgical variables, namely the location of surgical ports and the source of grafts used, and this creates challenge to anaesthesiologist to determine easy , safe and efficacious nerve block to be used in this setting .

A recently described popliteal plexus block(PPB) is claimed to anesthetize articular branches from the posterior obturator nerve and tibial nerve. It was recently confirmed in a cadaver study that injection of 10 mL of dye into the distal end of the adductor canal spreads via the adductor hiatus to the popliteal fossa and stains the popliteal plexus (PP).

A blockade of the popliteal plexus , has been claimed to produce an equivalent analgesic effect to sciatic nerve block after total knee arthroplasty without causing any motor weakness.

The current study hypothesize that combined saphenous nerve block with popliteal plexus block will enhance post operative analgesia after ACL reconstruction with motor sparing of thigh and leg muscles. Thus, faster recovery and earlier post-operative physiotherapy.

The objective of the current study is to evaluate analgesic effect of combined saphenous and popliteal plexus block as post -operative analgesia for anterior cruciate ligament reconstruction operation compared to standard saphenous nerve block .

Patients scheduled for ACL reconstruction will be randomly assigned into one of two groups:

the intervention group will receive popliteal plexus block and saphenous nerve block and the control group will receive the standard saphenous nerve block only.

• Phase: N/A
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: Fayoum University Hospital
• Treatments: Bupivacaine; Epinephrine; Epinephryl borate; Racepinephrine

Criteria

Inclusion Criteria:

• American Society of Anesthesiologist (ASA) physical status I/II/III .

• Age > 18 years.

• Body mass index of <40 kg/m2 .

Exclusion Criteria:

• Patient refusal,

• Un-cooperative patients

• BMI>40kg/m2 .

• Allergy to local anaesthetics.

• Anticoagulation or bleeding disorders.

• Pre-existing peripheral neuropathies.

• Inflammation or infection over injection site.

• Daily morphine consumption > 40 mg.