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A Retrospective Review of Femoral Nerve Block for Postoperative Analgesia After Knee Surgery in the Pediatric Population

Schloss, Brian MD*,†; Bhalla, Tarun MD*,†; Klingele, Kevin MD†,‡; Phillips, Daniel APN§; Prestwich, Bradley BS; Tobias, Joseph D. MD*,†

Journal of Pediatric Orthopaedics: June 2014 - Volume 34 - Issue 4 - p 459–461
doi: 10.1097/BPO.0000000000000113

Background: To investigate the outcomes of pediatric patients receiving a femoral nerve block (FNB) in addition to general anesthesia for arthroscopic knee surgery compared with those receiving general anesthesia alone.

Methods: This retrospective review included all patients undergoing arthroscopic knee surgery from January 2009 to January 2011 under general anesthesia both with and without a FNB. After the induction of general anesthesia, those patients selected for regional anesthesia received a FNB using real-time ultrasound or nerve stimulator guidance. For the FNB, 0.2 to 0.4 mL/kg of local anesthetic solution was injected around the femoral nerve at the level of the inguinal crease. Intra-articular injection of bupivacaine (0.25%, 10 mL) was administered by the surgeon for all patients not receiving a FNB. Additional analgesic medications, PACU length of stay, duration of hospitalization, hospital course, and any acute or nonacute complications were recorded and evaluated.

Results: There were no adverse effects related to the FNB. Using a 0 to 10 visual analogue scale (0=no pain), there was a statistically significant difference in both the high (4.0±4.0 vs. 5.3±3.1, P=0.0004) and low (1.5±1.8 vs. 2.1±2.0, P=0.002) pain scores in patients who received a FNB versus those who did not with the scores being lower in those who had received a FNB. There was a decreased need for the use of opioids postoperatively (61% vs. 71%, P=0.04) and a decreased duration of postoperative stay in patients who were admitted to the hospital (11.7±8.1 vs. 15.8±10 h, P=0.044) in individuals who had a FNB. There was a significantly lower admission rate in patients undergoing anterior cruciate ligament repair in the FNB group (72% vs. 95%, P=0.001). There was no difference in the incidence of postoperative nausea and vomiting between the groups.

Conclusion: After arthroscopic knee surgery in pediatric patients, a FNB shortens hospital stay, reduces opioid requirements, and decreases postoperative pain scores. For anterior cruciate ligament repairs, FNB lowers postoperative admission rates.

Clinical Evidence: Level III.

Departments of *Anesthesiology and Pain Medicine

Orthopedic Surgery

§Perioperative Services, Nationwide Children’s Hospital

The Ohio State University Medical Center

School of Medicine, The Ohio State University, Columbus, OH

The authors declare no conflicts of interest.

Reprints: Brian Schloss, MD, Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205. E-mail:

© 2014 by Lippincott Williams & Wilkins