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FEMORAL NERVE CATHETER IS ASSOCIATED WITH PERSISTENT STRENGTH DEFICITS AT 6 MONTHS FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN PEDIATRIC PATIENTS

BACKGROUND: The long-term outcomes of femoral nerve blockade following ACL reconstruction are not well defined. Femoral nerve blocks are typically administered as either a single-injection nerve block (FNB) or a continuous femoral nerve catheter (FNC). Prior work among pediatric patients found knee...

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Autores principales: Parikh, Harin B., Mandler, Tessa N., Gagliardi, Alexia G., Howell, David R., Albright, Jay C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7222264/
http://dx.doi.org/10.1177/2325967120S00204
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author Parikh, Harin B.
Mandler, Tessa N.
Gagliardi, Alexia G.
Howell, David R.
Albright, Jay C.
author_facet Parikh, Harin B.
Mandler, Tessa N.
Gagliardi, Alexia G.
Howell, David R.
Albright, Jay C.
author_sort Parikh, Harin B.
collection PubMed
description BACKGROUND: The long-term outcomes of femoral nerve blockade following ACL reconstruction are not well defined. Femoral nerve blocks are typically administered as either a single-injection nerve block (FNB) or a continuous femoral nerve catheter (FNC). Prior work among pediatric patients found knee extension and flexion strength deficits 6 months postoperatively using FNB. However, this work was limited by the use of multiple graft choices and orthopedic surgeons. PURPOSE/HYPOTHESIS: The purpose of this study was to investigate functional recovery after primary ACL surgery with quadriceps tendon-patellar autograft (QPA) in patients receiving a sciatic nerve block and either FNB or FNC. Our hypothesis was that short-term functional performance would be worse among those who underwent FNC compared to FNB. METHODS: We conducted a retrospective chart review of pediatric patients 10-19 years of age who underwent ACL reconstruction with QPA by a single orthopedic surgeon. Surgery was performed at two locations: one of which administered FNB and the other FNC. Both were combined with sciatic nerve block. A physical therapist performed functional asymmetry assessments at approximately 6 months postoperative. We compared single-leg squat symmetry between groups using independent samples t-tests. We compared the proportion of patients in each group who achieved 80% symmetry on single-leg squat and Y-Balance tests, had initiated ballistics and running programs, and demonstrated functional symmetry at the 6-month post-operative appointment using Chi-square analyses. RESULTS: Demographics were similar between groups (Table 1). Single leg percent symmetry of the operative limb was significantly greater in the FNB group compared to the FNC group (Table 2). In addition, a greater proportion of those in the FNB group demonstrated functional symmetry compared to the FNC group during the 6-month assessment (Table 2). There were no proportional differences between the groups for the number of patients who demonstrated 80% symmetry during single-leg squat or Y-Balance test, or had initiated a ballistics or running program at the time of assessment. CONCLUSION: Pediatric patients in the FNC group demonstrated poorer single-leg squat symmetry and functional symmetry compared to those in the FNB group at 7 months following ACL reconstruction with QPA. These preliminary findings may relate to increased concentration and duration of local anesthetic in the FNC group postoperatively. Providers should be cognizant of the implications of FNC on long-term outcomes of ACL reconstruction.
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spelling pubmed-72222642020-05-18 FEMORAL NERVE CATHETER IS ASSOCIATED WITH PERSISTENT STRENGTH DEFICITS AT 6 MONTHS FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN PEDIATRIC PATIENTS Parikh, Harin B. Mandler, Tessa N. Gagliardi, Alexia G. Howell, David R. Albright, Jay C. Orthop J Sports Med Article BACKGROUND: The long-term outcomes of femoral nerve blockade following ACL reconstruction are not well defined. Femoral nerve blocks are typically administered as either a single-injection nerve block (FNB) or a continuous femoral nerve catheter (FNC). Prior work among pediatric patients found knee extension and flexion strength deficits 6 months postoperatively using FNB. However, this work was limited by the use of multiple graft choices and orthopedic surgeons. PURPOSE/HYPOTHESIS: The purpose of this study was to investigate functional recovery after primary ACL surgery with quadriceps tendon-patellar autograft (QPA) in patients receiving a sciatic nerve block and either FNB or FNC. Our hypothesis was that short-term functional performance would be worse among those who underwent FNC compared to FNB. METHODS: We conducted a retrospective chart review of pediatric patients 10-19 years of age who underwent ACL reconstruction with QPA by a single orthopedic surgeon. Surgery was performed at two locations: one of which administered FNB and the other FNC. Both were combined with sciatic nerve block. A physical therapist performed functional asymmetry assessments at approximately 6 months postoperative. We compared single-leg squat symmetry between groups using independent samples t-tests. We compared the proportion of patients in each group who achieved 80% symmetry on single-leg squat and Y-Balance tests, had initiated ballistics and running programs, and demonstrated functional symmetry at the 6-month post-operative appointment using Chi-square analyses. RESULTS: Demographics were similar between groups (Table 1). Single leg percent symmetry of the operative limb was significantly greater in the FNB group compared to the FNC group (Table 2). In addition, a greater proportion of those in the FNB group demonstrated functional symmetry compared to the FNC group during the 6-month assessment (Table 2). There were no proportional differences between the groups for the number of patients who demonstrated 80% symmetry during single-leg squat or Y-Balance test, or had initiated a ballistics or running program at the time of assessment. CONCLUSION: Pediatric patients in the FNC group demonstrated poorer single-leg squat symmetry and functional symmetry compared to those in the FNB group at 7 months following ACL reconstruction with QPA. These preliminary findings may relate to increased concentration and duration of local anesthetic in the FNC group postoperatively. Providers should be cognizant of the implications of FNC on long-term outcomes of ACL reconstruction. SAGE Publications 2020-04-30 /pmc/articles/PMC7222264/ http://dx.doi.org/10.1177/2325967120S00204 Text en © The Author(s) 2020 https://creativecommons.org/licenses/by-nc-nd/4.0/ This open-access article is published and distributed under the Creative Commons Attribution - NonCommercial - No Derivatives License (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits the noncommercial use, distribution, and reproduction of the article in any medium, provided the original author and source are credited. You may not alter, transform, or build upon this article without the permission of the Author(s). For article reuse guidelines, please visit SAGE’s website at http://www.sagepub.com/journals-permissions.
spellingShingle Article
Parikh, Harin B.
Mandler, Tessa N.
Gagliardi, Alexia G.
Howell, David R.
Albright, Jay C.
FEMORAL NERVE CATHETER IS ASSOCIATED WITH PERSISTENT STRENGTH DEFICITS AT 6 MONTHS FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN PEDIATRIC PATIENTS
title FEMORAL NERVE CATHETER IS ASSOCIATED WITH PERSISTENT STRENGTH DEFICITS AT 6 MONTHS FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN PEDIATRIC PATIENTS
title_full FEMORAL NERVE CATHETER IS ASSOCIATED WITH PERSISTENT STRENGTH DEFICITS AT 6 MONTHS FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN PEDIATRIC PATIENTS
title_fullStr FEMORAL NERVE CATHETER IS ASSOCIATED WITH PERSISTENT STRENGTH DEFICITS AT 6 MONTHS FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN PEDIATRIC PATIENTS
title_full_unstemmed FEMORAL NERVE CATHETER IS ASSOCIATED WITH PERSISTENT STRENGTH DEFICITS AT 6 MONTHS FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN PEDIATRIC PATIENTS
title_short FEMORAL NERVE CATHETER IS ASSOCIATED WITH PERSISTENT STRENGTH DEFICITS AT 6 MONTHS FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN PEDIATRIC PATIENTS
title_sort femoral nerve catheter is associated with persistent strength deficits at 6 months following anterior cruciate ligament reconstruction in pediatric patients
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7222264/
http://dx.doi.org/10.1177/2325967120S00204
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