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A Practical Guide to Lower Extremity Nerve Blocks for the Sports Medicine Surgeon
Connor R Crutchfield1, Eric A Schweppe1, Ajay S Padaki1
1Columbia University Irving Medical Center, New York, New York, USA.
The American Journal of Sports Medicine
|April 19, 2022
Summary
Peripheral nerve blocks (PNBs) offer safe and effective pain control for lower extremity arthroscopy. Ultrasound-guided PNBs significantly reduce pain and opioid use, but require vigilance for potential complications like falls.
Area of Science:
- Orthopaedic Surgery
- Pain Management
- Anesthesiology
Background:
- Peripheral nerve blocks (PNBs) are increasingly utilized for analgesia in lower extremity arthroscopic procedures.
- Selecting the optimal PNB for specific hip and knee arthroscopy procedures can be challenging for orthopaedic surgeons.
Approach:
- A narrative literature review was conducted to identify and evaluate PNBs for arthroscopic hip and knee surgery.
- Searches encompassed major medical databases using terms for PNBs and arthroscopic procedures, focusing on placement, efficacy, and complications.
Key Points:
- Femoral, lumbar plexus, sciatic, and fascia iliaca blocks are common for hip arthroscopy; femoral, 3-in-1, and adductor canal blocks for knee arthroscopy.
- All reviewed PNBs demonstrated significant benefits in reducing intraoperative morphine, pain scores, nausea, and/or opioid consumption (P > .05).
- Ultrasound-guided PNBs reported complication rates from 0% to 4.8%, including weakness, falls, neuropathy, and hematomas.
Conclusions:
- PNBs are a safe and effective adjunct for postoperative pain control, significantly reducing narcotic requirements.
- Ultrasound guidance is recommended for all PNBs, alongside protocols to manage the risk of postoperative falls.
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