Research

Postoperative Analgesia comparing Subsartorial Saphenous Nerve Block with and without Dexamethasone in ACL Reconstruction

IRB Number: 2012-002

Institutional Review Board, Hospital for Special Surgery

May 24, 2012

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Principal Investigator

Mary F. Chisholm, MD

Co-Investigators

Gregory A. Liguori, MD
Daniel B. Maalouf, MD, MPH
Jacques YaDeau, MD, PhD
Robert G. Marx, MD
Jodie Curren, RN
Carey Ford
Michael Gordon
Mandip Kalsi
Shane Reid
Victor M. Zayas, MD

Summary

For patients undergoing ACL reconstruction surgery, the postoperative period can be a painful experience without adequate pain management. Hence we propose a randomized controlled clinical study, investigating prolonged saphenous nerve blocks. Patients will be randomized to receive saphenous nerve blocks with or without dexamethasone, a corticosteroid used to prolong analgesia.

Depending on the randomized treatment assignment, patients may receive one of the following:
1) local anesthetic with 2 ml of saline (no dexamethasone);
2) local anesthetic mixed with 2 mg of dexamethasone;
3) local anesthetic mixed with 4 mg of dexamethasone.

Patients will be followed postoperatively. Following admission to the recovery room, data collectors will ask patients to rate their pain on a scale of 0-10 until discharge. Data collectors will also record patient satisfaction, pain medication use and any side effects experienced (i.e. nausea and vomiting). Patients will then be contacted on postoperative days 1, 2 and 14 and asked questions about their general well-being.

Inclusion/Exclusion Criteria

Inclusion Criteria
- All ASA I-III patients undergoing ambulatory surgery for ACL reconstruction with a patella tendon autograft.
- BMI <35
- Smokers included
- Ages 16-65

• Exclusion Criteria
- Patients on steroids or requiring stress dose steroids
- BMI >35
- Patient refusal
- Allergy to study medications,
- NRS scores >3 with frequent opioid use (including tramadol) prior to surgery—daily for greater than 3 weeks
- Lower extremity neurological dysfunction
- Diabetic (NIDDM, insulin-dependent and/or oral hypoglycemic dependent)
- Under 16 years of age and over 65 years of age
- Contraindications to the use of dexamethasone
- Non-English speaking patients (questionnaires to be used have been validated in English only thus far)

Contact Information

Carey Ford
fordc@hss.edu
212.606.1206



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