BOS-1
Adductor Canal Catheter Versus Femoral Nerve Catheter for Analgesia in Pediatric Patients After Anterior Cruciate Ligament Reconstruction
Robbins R, Low D, Schmale G
Seattle Children’s Hospital, Seattle, WA, USA
Introduction
Femoral nerve catheters (FNC) have become a popular method of post-operative analgesia for anterior cruciate ligament (ACL) reconstruction in pediatric patients. However, femoral nerve blocks result in quadriceps muscle weakness, leading to concerns about early mobilization and subsequent recovery. Unlike FNC, adductor canal catheters (ACC) preserve quadriceps muscle strength compared to FNC with similar analgesic efficacy in adult patients.1,2 Similar studies comparing FNC to ACC in pediatric patients is lacking.
The aim of this study was to compare the effects of ACC to FNC on intra-operative and post-operative pain, patient satisfaction, and return of quadriceps function and sports readiness. We hypothesized that ACC compared to FCC would result in decreased time to sports readiness without compromising analgesia.
Methods
This retrospective non-randomized experimental study compares the early post-operative analgesic and antiemetic requirements of the last 42 patients 21 years of age and younger undergoing ACL reconstruction with hamstring autograft in 2016 with a femoral nerve catheter (FNC) and single shot sciatic block to the first 30 patients of 2017 with similar demographics undergoing the same surgery with an adductor canal catheter (ACC) and single shot sciatic block. Patient demographics, intra-operative fentanyl supplementation, post-anesthesia recovery unit (PACU) length of stay (LOS), PACU maximum pain scores, the need for rescue antiemetic medications, and PACU morphine supplementation for elevated and resistant pain scores were compared between groups.
Results
Patient demographics were comparable between the two groups. Intra-operative fentanyl supplementation was significantly greater in the ACC group (1.9 mcg/kg vs. 1.4 mcg/kg FNC; p = 0.005). There was a significant difference in mean PACU LOS comparing the two groups, FNC vs. ACC: 105 min average (range 77-135 min) vs. 117 min (range 89-148 min), respectively (p < 0.05). The mean PACU maximum reported pain scores were slightly lower in the FNC group (3.00 vs. 3.73), with the most common score equal zero (26.0% FNC vs. 33.3% ACC patients). No rescue antiemetic was necessary in 37/42 (88%) of FNC patients and 28/30 (93%) of ACC patients. No PACU morphine, for persistently elevated pain scores, was necessary for 36/42 (86%) of FNC patients and 27/30 (90%) of ACC patients.
Discussion
Although there were significant differences in mean intra-operative fentanyl supplementation and PACU lengths of stay, these difference are thought to be of little clinical significance, given the similar maximum PACU pain scores, morphine rescue rates and PONV rescue rates when comparing the two groups. This is the first comparative study of ACC versus FCC in pediatric patients undergoing ACL reconstruction.
Conclusion
In conclusion, ACCs provide adequate intra-operative and early post-operative analgesia during and following ACL reconstruction when compared to FNC, while potentially sparing quadriceps function, essential for early and optimal recovery after ACL reconstruction in pediatric patients.
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