Common Peroneal Nerve Analgesia Considerations During Knee Posterolateral Corner Reconstruction

Area of Science:

• Orthopedic Surgery
• Pain Management
• Neurology

Background:

• Peripheral nerve blockade, specifically common peroneal nerve (CPN) analgesia, is standard for posterolateral corner (PLC) knee reconstructions.
• CPN blockade can hinder immediate postoperative assessment for iatrogenic injury and may worsen existing CPN trauma.
• Lack of lateral knee analgesia may necessitate postoperative rescue blocks.

Purpose of the Study:

• To determine the incidence of iatrogenic peroneal nerve injury after PLC reconstruction.
• To assess the frequency of postoperative rescue blocks in CPN-sparing analgesia protocols.
• To inform optimal perioperative anesthesia protocols for PLC knee surgery.

Main Methods:

• Retrospective review of 50 patients undergoing PLC reconstruction over 4 years at a Level 1 academic institution.
• Data collection included demographics, injury patterns, nerve blockade type, surgical interventions, and perioperative nerve injury.
• Analysis of factors influencing CPN blockade avoidance and rescue block requirements.

Main Results:

• 20% of patients had preoperative CPN injury; 40% of these required further intervention post-neurolysis.
• CPN blockade was avoided in cases of preoperative CPN injury (p=0.030) and low-energy mechanisms (p=0.038).
• 45% of the CPN-sparing group required a rescue block, associated with younger age (p=0.007) and lower BMI (p=0.035).
• Iatrogenic CPN palsy occurred in 6% of cases, all incomplete and non-operative.

Conclusions:

• Avoiding preoperative CPN blockade allows for immediate postoperative neurologic evaluation.
• Nearly half of patients undergoing CPN-sparing analgesia require a postoperative rescue block.
• The incidence of iatrogenic CPN injury following PLC reconstruction is low, with incomplete palsies observed.