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Anesth Analg 2005;101:1304-1310
© 2005 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000180218.54037.0B

PEDIATRIC ANESTHESIA

Intraarticular Bupivacaine-Clonidine-Morphine Versus Femoral-Sciatic Nerve Block in Pediatric Patients Undergoing Anterior Cruciate Ligament Reconstruction

Kha M. Tran, MD*, Theodore J. Ganley, MD{dagger}, Lawrence Wells, MD{dagger}, Arjunan Ganesh, MBBS*, Kimberly I. Minger, BSN{ddagger}, and Giovanni Cucchiaro, MD*

Departments of *Anesthesiology and Critical Care Medicine, {dagger}Orthopaedic Surgery, and {ddagger}Clinical Research, Children’s Hospital of Philadelphia, Pennsylvania

Address correspondence to Giovanni Cucchiaro, MD, Children’s Hospital of Philadelphia, Room, 9th Floor, 34th St. and Civic Center Blvd., Philadelphia, PA 19104. Address e-mail to Cucchiaro{at}email.chop.edu.

We hypothesized that combined femoral-sciatic nerve block (FSNB) offers better analgesia with fewer side effects than intraarticular infiltration (IA) in children undergoing anterior cruciate ligament (ACL) reconstruction. Thirty-six children undergoing ACL reconstruction were randomized to FSNB or IA. FSNB patients had FSNB with bupivacaine (0.125%)-clonidine (2 µg/kg), whereas IA patients received bupivacaine (0.25%)-clonidine (1 µg/kg)-morphine (5 mg). Postoperatively, analgesia was provided with patient-controlled analgesia and rescue morphine. Patient demographics were similar. FSNB patients required less intraoperative fentanyl (50 ± 40 µg versus 80 ± 50 µg; P = 0.04). Visual analog scale score for FSNB was smaller than IA in the recovery room (1.8 ± 3 versus 5.4 ± 3; P = 0.0002) and during the first 24 h (1.6 ± 1 versus 2.9 ± 2; P = 0.01)). FSNB morphine use in the first 18 h was less (7 ± 13 mg versus 21 ± 21 mg; P = 0.03). Fewer FSNB patients vomited (11% versus 50%; P = 0.03). IA patients required morphine patient-controlled analgesia sooner. After ACL reconstruction in children, FSNB with bupivacaine-clonidine provides better analgesia with fewer side effects than IA with bupivacaine-clonidine-morphine.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2005 by the International Anesthesia Research Society.