J Med Assoc Thai 2012; 95 (11):1418

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Single Injection Fascia Iliaca Block for Pain Control after Arthroscopic Anterior Cruciate Ligament Reconstruction: A Randomized, Controlled Trial
Wongswadiwat M Mail, Pathanon P , Sriraj W , Ratanasuwan Yimyaem P , Bunthaothuk S

Background: Arthroscopic anterior cruciate ligament reconstruction (AACLR) is one of the orthopedic surgeries associated with moderate to severe post-operative pain. The fascia iliaca block (FIB), a block of the femoral nerve and lateral femoral cutaneous nerve of the thigh, is relatively simple, safe, and provides effective analgesia post-operatively.

Objective: To investigate the effectiveness of using fascia iliaca block for post-operative pain relief after AACLR.

Material and Method: After approval by the Ethics Committee for Khon Kaen University (HE510817), the patients were randomly allocated into two groups using a computer-generated random number and concealed by sealed opaque envelopes. FIB was delivered via a 16-gauge Tuohy needle at the PACU. The patients received either 0.25% bupivacaine with adrenaline or 0.9% NSS 40 mL. Morphine consumption, time to first rescue analgesia, Numerical Rating Scale (NRS), side effects, and complication within 24 hours were recorded.

Results: Forty-seven patients were enrolled. There was a statistically significant difference in the 24 hours morphine consumption between the bupivacaine and NSS groups (22.1 ± 7.2 and 31.8 ± 9.3 mg, respectively; p < 0.001). Time to first rescue analgesia was significantly longer in the bupivacaine group (4.60 ± 2.2 vs. 2.83 ± 1.6 hour, p 0.003). The difference of resting and on movement pain score were also significant (2.1 (95% CI 1.3-2.8), p < 0.001 and 1.8 (95% CI 1.2-2.4), p < 0.001 respectively. Neither serious side effect nor neurological sequel was found.

Conclusion: The fascia iliaca block is effective for providing pain control for at least 24 hours after anterior cruciate ligament reconstruction. This technique is quite easy, safe, and inexpensive to use.

Keywords: Fascia iliaca block, Anterior cruciate ligament reconstruction, Post-operative pain control, Morphine consumption

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