Effectiveness of Continuous Femoral Nerve Block Versus Single Shot Femoral Nerve Block for Pain Control

The number of ambulatory procedures has steadily increased over the last decade.
Postoperative pain is the most common cause of delayed discharge and unexpected admission
after ambulatory surgery. Knee surgery was identified as one of the procedures associated
with the most pain at 24 hours, with a 45% or higher incidence of moderate or severe pain.
Poor pain control can counteract many of the benefits of ambulatory surgery and can lead to
the development of chronic pain.

Regional techniques have been shown to be effective after ACL reconstruction, allowing
faster patient recovery with fewer side-effects than intravenous administration of opioids.
Different regional techniques have been applied and studied after ACLR. Femoral nerve block
for ACLR either as a single bolus or as a continuous infusion markedly decreases intravenous
analgesic requirements and postoperative pain. To our knowledge, no study has compared these
two techniques after ACLR with patellar tendon graft or allograft.

Inclusion Criteria:

1. American Society of Anesthesiologists score between 1-3

2. Scheduled to undergo Anterior Cruciate Ligament reconstruction with patellar tendon
graft or allograft under general anesthesia

Exclusion Criteria:

1. Localized infection of the groin or generalized sepsis.

2. Hypersensitivity or known allergy to local anesthetics.

3. Preexisting nerve damage in surgical limb.

4. History of chronic pain with either (a) daily opioid requirement exceeding the
equivalent of 50 mg morphine or (b) daily prescription of tricyclic antidepressants,
gabapentin, pregabalin, or tramadol for pain.

5. Patients who elect to have knee surgery under spinal anesthesia or who cannot undergo
general anesthetic.

6. Patients who decline to have a femoral nerve block with catheter.