Anesthesia and analgesia methods for outpatient anterior cruciate ligament reconstruction
Autor: | X. Roussignol, R. Letartre, Nicolas Lefevre, T. Cucurulo, François Dalmay, C. Lutz, Elvire Servien, L. Baverel, J. Cournapeau, L. Surdeau, Colombet, J.-F. Potel |
---|---|
Rok vydání: | 2016 |
Předmět: |
Adult
Male medicine.medical_specialty Anterior cruciate ligament reconstruction Adolescent Visual Analog Scale Visual analogue scale medicine.medical_treatment Anterior cruciate ligament Analgesic Outpatient surgery Cryotherapy Anesthesia General Anesthesia Spinal 03 medical and health sciences Young Adult 0302 clinical medicine 030202 anesthesiology Medicine Humans Orthopedics and Sports Medicine Prospective Studies Risk factor Anesthetics Local Glucocorticoids 030222 orthopedics Pain Postoperative Anterior Cruciate Ligament Reconstruction business.industry Gold standard Anti-Inflammatory Agents Non-Steroidal Nerve Block Middle Aged Patient Discharge Surgery medicine.anatomical_structure Ambulatory Surgical Procedures Anesthesia Female France business |
Zdroj: | Orthopaedicstraumatology, surgeryresearch : OTSR. 102(8S) |
ISSN: | 1877-0568 |
Popis: | More and more anterior cruciate ligament (ACL) reconstructions are being performed as outpatient surgery in France, because of economic considerations. Postoperative pain is the most common reason for delayed discharge that could require hospitalization, and the main reason for unanticipated hospital admission. The purpose of this study was to define the best anesthesia and analgesia methods for ACL reconstruction.This was a prospective, multicenter, comparative study performed between January 2014 and April 2015. Inclusion criteria were ACL reconstruction in patients above 15 years of age performed as an outpatient surgical procedure. The anesthesia techniques analyzed were general anesthesia, spinal anesthesia and quadruple nerve blockade. The analgesic methods studied were single-shot nerve blocks, continuous nerve blocks, peri-articular and intra-articular local infiltration analgesia (LIA), non-steroidal anti-inflammatory agents (NSAIDs) and intravenous corticosteroids. The main outcome criterion was pain on a visual analog scale (VAS). The secondary outcome criteria were delayed discharge of a patient who had undergone outpatient surgery, consumption of opioids and complications for the various anesthesia techniques and analgesia methods.In all, 680 patients were included in this study, which was 63% of the ACL reconstruction procedures performed during this period. The study population was 69% male and 31% female, with an average age of 30 years. Twenty-three patients (3.4%) could not be discharged on the day of surgery. No correlation was found with the anesthesia technique used. NSAID treatment was protective relative to delayed discharge (P=0.009), while opioid consumption was a risk factor (P0.01). There were no differences in the pain levels related to the type of anesthesia. Peri-articular LIA of the hamstring tendon harvest site was effective. Intra-articular LIA did not provide better analgesia. Continuous nerve block had complication rates above 13%.All types of anesthesia were compatible with outpatient ACL reconstruction. No gold standard analgesia method can be defined based on this study's findings. However, we recommend multimodal analgesia associating peri-articular LIA or one-shot sensory saphenous nerve block, NSAIDs and corticosteroid treatment, and cryotherapy.II, prospective comparative non-randomized study. |
Databáze: | OpenAIRE |
Externí odkaz: |