This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Tran, K. M. Articles by Cucchiaro, G. Search for Related Content PubMed PubMed Citation Articles by Tran, K. M. Articles by Cucchiaro, G. Related Collections Pediatrics Regional Anesthesia Pain Pharmacology

---

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, Lawrence Wells, MD, Arjunan Ganesh, MBBS^*, Kimberly I. Minger, BSN, and Giovanni Cucchiaro, MD^*

Departments of *Anesthesiology and Critical Care Medicine, Orthopaedic Surgery, and 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.