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2. Postoperative Analgesia with Saphenous Block Appears Equivalent to Femoral Nerve Block in ACL Reconstruction

Author

Chisholm, Mary F, Bang, Heejung, Maalouf, Daniel B, Marcello, Dorothy, Lotano, Marco A, Marx, Robert G, Liguori, Gregory A, Zayas, Victor M, Gordon, Michael A, Jacobs, Jason, and YaDeau, Jacques T

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Neurosciences, Chronic Pain, Physical Injury - Accidents and Adverse Effects, Pain Research, Clinical Research, 6.1 Pharmaceuticals, Evaluation of treatments and therapeutic interventions, Musculoskeletal, ACL reconstruction, femoral nerve block, pain, postoperative analgesia, saphenous nerve block, Public Health and Health Services, Orthopedics, Clinical sciences
Abstract

BackgroundAdequate pain control following anterior cruciate ligament reconstruction (ACL) often requires regional nerve block. The femoral nerve block (FNB) has been traditionally employed. Ultrasound application to regional nerve blocks allows for the use of alternatives such as the saphenous nerve block following ACL reconstruction.Questions/purposesThis study evaluated postoperative analgesia provided by the subsartorial saphenous nerve block (SSNB) compared to that provided by the traditional FNB for patients undergoing ACL reconstruction with patellar tendon (bone-tendon-bone (BTB)) autografts.MethodsA randomized, blinded, controlled clinical trial was conducted using 80 ASA I-III patients, ages 16-65, undergoing ACL reconstruction with BTB. The individuals assessing all outcome measures were blinded to the treatment group. Postoperatively, all patients received cryotherapy and parenteral hydromorphone to achieve numeric rating scale pain scores less than 4. At discharge, patients were given prescriptions for oral opioid analgesics and a scheduled NSAID. Patients were instructed to complete pain diaries and record oral opioid utilization. Patients were contacted on postoperative days (POD) 1 and 2 to ascertain the level of patient satisfaction with the analgesic regimen.ResultsNo differences between the two groups were found. Patient demographics and postoperative pain scores at rest were not different. In addition, there was no difference in opioid use, as measured in daily oral morphine equivalents between groups. A small but statistically significant report of higher patient satisfaction with the FNB was found on POD 1 but not on POD 2.ConclusionThese data support our hypothesis that the SSNB provides similar and adequate postoperative analgesia when compared to the FNB, following arthroscopic ACL reconstruction with patellar tendon autograft.

Published
2014

4. List of Contributors

Author

Ahmad, Sufian S., primary, Akita, Keiichi, additional, Alvarez, Pedro, additional, Amis, Andrew A., additional, Andrews, James R., additional, Anz, Adam W., additional, Ares, Oscar, additional, Argentieri, Erin C., additional, Avbelj, Viktor, additional, Balazs, George C., additional, Barber, F. Alan, additional, Barber-Westin, Sue D., additional, Bareka, Metaxia, additional, Barnthouse, Cris D., additional, Barrett, Austin M., additional, Barrett, Gene R., additional, Basdekis, George, additional, Beck, Charles L., additional, Bedi, Asheesh, additional, Benner, Rodney W., additional, Bernard, Manfred, additional, Bernholt, David L., additional, Beynnon, Bruce D., additional, Bisson, Leslie J., additional, Björnsson, Haukur, additional, Blagojevic´, Zoran, additional, Bogunovic, Ljiljana, additional, Briggs, Karen, additional, Brophy, Robert, additional, Brotherton, Scott L., additional, Brown, Charles H., additional, Brown, Taylor D., additional, Browne, Jon E., additional, Chahla, Jorge, additional, Chau, Jackie Yee-Man, additional, Chan, William Wai-Lam, additional, Chisholm, Mary F., additional, Cole, Brian J., additional, Collins, Amber T., additional, Collins, Malcolm, additional, Crossley, Kay M., additional, Cugat, Ramón, additional, Cuscó, Xavier, additional, DeBerardino, Thomas M., additional, Denaro, Vincenzo, additional, Dreese, James C., additional, Dukas, Alex G., additional, Duthon, Victoria B., additional, Ejerhed, Lars, additional, Ernest, Christian, additional, Evangelopoulos, Dimitrios S., additional, Everhart, Joshua S., additional, Fabricant, Peter D., additional, Feller, Julian A., additional, Fideler, Kathryn, additional, Filbay, Stephanie R., additional, Finkle, Susan M., additional, Flanigan, David C., additional, Francisco, Ramces, additional, Frank, Rachel M., additional, Fromm, Stuart E., additional, Fu, Freddie H., additional, Fulkerson, John P., additional, Ganapathy, Pramodh K., additional, Ganley, Theodore J., additional, Garrett, William E., additional, Georgoulis, Anastasios, additional, Gill, Thomas J., additional, Gornitzky, Alex L., additional, Goyeneche, Nicholas P., additional, Gray, Tinker, additional, Griffin, Letha Y., additional, Griffith, Chad J., additional, Gobbi, Alberto, additional, Guenther, Daniel, additional, Hackel, Joshua G., additional, Hadjicostas, Panayiotis T., additional, Han, Yung, additional, Hantes, Michael E., additional, Harlem, Thomas, additional, Harris, Joshua D., additional, Hecker, Aaron, additional, Ho, Sherwin S.W., additional, Howell, Stephen M., additional, Hutchinson, Mark R., additional, Imbert, Pierre, additional, Indelicato, Peter A., additional, Inderhaug, Eivind, additional, Irarrázaval, Sebastián, additional, Janssen, Daan Martijn, additional, Janssen, Rob P.A., additional, Järvelä, Timo, additional, Javernick, Matt, additional, Jiang, Jie, additional, Johnson, Darren L., additional, Johnson, Don, additional, Joyce, Brian T., additional, Jung, Min, additional, Kaeding, Christopher C., additional, Kalawadia, Jay V., additional, Kamath, Ganesh, additional, Karistinos, Anastassios, additional, Karlsson, Jón, additional, Karnatzikos, Georgios, additional, Kartus, Jüri, additional, Keating, John, additional, Kennedy, Nicholas I., additional, Kercher, James, additional, Khan, Umar, additional, Kim, Walter, additional, Kluczynski, Melissa A., additional, Koh, Jason L., additional, Kohl, Sandro, additional, Kousa, Petteri, additional, LaPrade, Christopher M., additional, LaPrade, Robert F., additional, Laupattarakasem, Pat, additional, Laupattarakasem, Wiroon, additional, Lawhorn, Keith W., additional, Leong, Natalie L., additional, Loveland, Dustin M., additional, Lynch, T. Sean, additional, Mackay, Gordon, additional, Maffuli, Nicola, additional, Magnussen, Robert A., additional, Maloney, Mike, additional, Mandelbaum, Bert R., additional, Mardam-Bey, Sami W., additional, Marx, Robert G., additional, McAllister, David R., additional, McCarty, Eric, additional, McCullough, Kirk A., additional, Menon, Sanjay, additional, Meuffels, Duncan E., additional, Metzler, Adam V., additional, Michaelson, Jefferey, additional, Mijic, Dragomir, additional, Milano, Giuseppe, additional, Milisavljevic´, Milan, additional, Mithoefer, Kai, additional, Mlynarek, Ryan A., additional, Mochizuki, Tomoyuki, additional, Mohankumar, Rakesh, additional, Moraiti, Constantina, additional, Moran, Ray, additional, Moulton, Samuel G., additional, Mudhigere, Abhishek, additional, Muneta, Takeshi, additional, Murphy, Brian J., additional, Nakamura, Norimasa, additional, Naraghi, Ali M., additional, Nicandri, Gregg, additional, Nikolic´, Valentina, additional, Noyes, Frank R., additional, Nurmi, Janne T., additional, O’Byrne, John, additional, Ochi, Mitsuo, additional, Paessler, Hans Heinrich, additional, Pandit, Hemant, additional, Papalia, Rocco, additional, Pappas, Evangelos, additional, Paschos, Nikolaos K., additional, Patzakis, Michael J., additional, Paulos, Lonnie E., additional, Peterson, Lars, additional, Philippon, Marc J., additional, Poage, Chad H., additional, Posthumus, Michael, additional, Prodromos, Chadwick C., additional, Rashkovska, Aleksandra, additional, Reijman, Max, additional, Rennicke, Jordan C., additional, Ristanis, Stavros, additional, Rius, Marta, additional, Rogowski, Julie, additional, Rossi, Nicholas, additional, Rue, John-Paul, additional, Saccomanno, Maristella F., additional, Sallent, Andrea, additional, Sasaki, Norihiro, additional, Sayde, William M., additional, Scheffler, Sven, additional, Schlatterer, Bernard, additional, Schmitt, Laura C., additional, Schoenfeldt, Ted, additional, Seijas, Roberto, additional, September, Alison V., additional, Shaarani, Shahril R., additional, Shaikh, Humza S., additional, Shaw, Christopher M., additional, Shelbourne, K. Donald, additional, Shelton, Walter, additional, Shin, Jason J., additional, Shino, Konsei, additional, Silvers, Holly J., additional, Simeoforidou, Marina, additional, Sims, Laura A., additional, Sklar, Joseph H., additional, Smith, Angela H., additional, Smyth, Mark P., additional, Sommerfeldt, Mark F., additional, Spindler, Kurt P., additional, Steiner, Mark E., additional, Stergiou, Nicholas, additional, Stevanovic´, Vladan, additional, Tecame, Andrea, additional, Tejwani, Samir G., additional, Terzidis, Ioannis, additional, Thoma, Louise, additional, Tilton, Annemarie K., additional, Timmerman, Laura A., additional, Tohyama, Harukazu, additional, Tsarouhas, Alexander, additional, Tsepis, Elias, additional, Trobec, Roman, additional, Lee Turnbull, Travis, additional, Uribe, John W., additional, van Meer, Belle L., additional, van Mourik, Jan B.A., additional, Van Thiel, Geoffrey, additional, Varkey, Dax, additional, Vasta, Sebastiano, additional, Veselko, Matjaž, additional, Wade, Sean M., additional, Wall, Andrew, additional, Ware, James Kristopher, additional, Waterman, Brian R., additional, Webster, Kate E., additional, Westermann, Robert W., additional, Wolf, Brian R., additional, Wright, Rick W., additional, Xergia, Sofia A., additional, Xerogeanes, John William, additional, Yanke, Adam, additional, Yasuda, Kazunori, additional, Yi, Seung Jin, additional, Zalavras, Charalampos G., additional, Zampeli, Franceska, additional, Zarins, Bertram, additional, and Zhao, Jinzhong, additional

Published
2018
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9. Phases of a Pandemic Surge: The Experience of an Ethics Service in New York City during COVID-19

Author

Huberman, Barrie J., primary, Mukherjee, Debjani, additional, Gabbay, Ezra, additional, Knowlton, Samantha F., additional, Green, Douglas S.T., additional, Pandya, Nekee, additional, Meredyth, Nicole, additional, Walker, Joan M., additional, Shapiro, Zachary E., additional, Hersh, Jennifer E., additional, Chisholm, Mary F., additional, Waldman, Seth A., additional, MacKenzie, C. Ronald, additional, de Melo-Martín, Inmaculada, additional, and Fins, Joseph J., additional

Published
2020
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12. Risk of postoperative hypoxemia in ambulatory orthopedic surgery patients with diagnosis of obstructive sleep apnea: a retrospective observational study

Author

Ma Yan, Ngeow Justin, John Raymond S, Chisholm Mary F, Liu Spencer S, and Memtsoudis Stavros G

Subjects
Surgery, RD1-811
Abstract

Abstract Background It is unclear when it is safe to discharge patients with a diagnosis of Obstructive Sleep Apnea (OSA) after ambulatory surgical procedures due to concern for postoperative respiratory compromise and hypoxemia. Our OSA patients undergoing ambulatory-type orthopedic procedures are monitored overnight in the PACU, thus we reviewed patient records to determine incidence of complications. Methods Two hundred and six charts of patients with preoperative diagnosis of OSA based on ICD-9 codes were reviewed for outcomes including episodes of hypoxemia. Univariate analysis followed by logistic regression and propensity analysis was performed to determine independent risk factors for hypoxemia and association with adverse outcomes. Results The majority of patients had regional anesthesia (95%). Thirty four percent of patients had hypoxemia in the PACU. Initial risk factors for hypoxemia identified by univariate analysis were BMI ≥ 35, increased age, history of COPD, upper extremity procedure, and use of peripheral nerve block. Independent risk factors identified by logistic regression were history of COPD (OR 3.64 with 95% CI 1.03-12.88) and upper extremity procedure (2.53, 1.36-4.68). After adjustment with propensity scores, adverse events were rare, and unplanned hospital admission after PACU stay was not increased with hypoxemia (11% vs 16%) Conclusions Episodes of postoperative hypoxemia in OSA patients undergoing ambulatory surgery with regional anesthesia are not associated with increased adverse outcomes or unplanned hospital admission.

Published
2010
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19. Postoperative Analgesia with Saphenous Block Appears Equivalent to Femoral Nerve Block in ACL Reconstruction.

Author

Chisholm MF, Bang H, Maalouf DB, Marcello D, Lotano MA, Marx RG, Liguori GA, Zayas VM, Gordon MA, Jacobs J, and YaDeau JT

Abstract

Background: Adequate pain control following anterior cruciate ligament reconstruction (ACL) often requires regional nerve block. The femoral nerve block (FNB) has been traditionally employed. Ultrasound application to regional nerve blocks allows for the use of alternatives such as the saphenous nerve block following ACL reconstruction., Questions/purposes: This study evaluated postoperative analgesia provided by the subsartorial saphenous nerve block (SSNB) compared to that provided by the traditional FNB for patients undergoing ACL reconstruction with patellar tendon (bone-tendon-bone (BTB)) autografts., Methods: A randomized, blinded, controlled clinical trial was conducted using 80 ASA I-III patients, ages 16-65, undergoing ACL reconstruction with BTB. The individuals assessing all outcome measures were blinded to the treatment group. Postoperatively, all patients received cryotherapy and parenteral hydromorphone to achieve numeric rating scale pain scores less than 4. At discharge, patients were given prescriptions for oral opioid analgesics and a scheduled NSAID. Patients were instructed to complete pain diaries and record oral opioid utilization. Patients were contacted on postoperative days (POD) 1 and 2 to ascertain the level of patient satisfaction with the analgesic regimen., Results: No differences between the two groups were found. Patient demographics and postoperative pain scores at rest were not different. In addition, there was no difference in opioid use, as measured in daily oral morphine equivalents between groups. A small but statistically significant report of higher patient satisfaction with the FNB was found on POD 1 but not on POD 2., Conclusion: These data support our hypothesis that the SSNB provides similar and adequate postoperative analgesia when compared to the FNB, following arthroscopic ACL reconstruction with patellar tendon autograft.

Published
2014
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