Proximal sciatic nerve block reduced pain after MPFL reconstruction in pediatric patients
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Results showed the addition of a single-injection proximal sciatic nerve block to an adductor canal block significantly reduced pain and opioid requirements in pediatric patients undergoing medial patellofemoral ligament reconstruction.
Researchers performed a retrospective cohort study on 144 pediatric patients who underwent (MPFL reconstruction with peripheral nerve blockade for postoperative analgesia from 2016 to 2020. According to the study, 62 patients received an adductor canal or femoral nerve continuous peripheral nerve block (CPNB) and 82 patients received an adductor canal CPNB with an additional single-injection proximal sciatic block.
Outcome measures included opioid requirements in morphine equivalents and number of patients achieving a patient acceptable symptom state (PASS) – defined by a VAS pain score of less than 4.
Researchers found 52% of patients (n = 43) who received the additional single-injection proximal sciatic block achieved the PASS for the 24-hour postoperative period, while 21% of patients (n = 13) who did not receive the proximal sciatic block achieved the same PASS. Patients who received the additional proximal sciatic block had a mean pain score of 2 and maximum pain score of 3.1, while patients who did not receive the proximal sciatic block had a mean pain score of 3.6 and maximum pain score of 4.9.
Additionally, researchers found a significant reduction in opioid requirements in the first 24 hours after surgery for the proximal sciatic block group (0.09 in morphine equivalents) vs. the no proximal sciatic block group (0.25 in morphine equivalents).
“The addition of a proximal sciatic nerve block was associated with significantly reduced mean and maximum pain scores and opioid requirements for 24 hours after surgery and supports a randomized clinical trial to confirm these findings,” the researchers wrote in the study. “Based on the results of this study, we recommend the addition of a proximal sciatic nerve block, anterior or posterior, to an adductor canal block to provide improved analgesia and reduced opioid requirements in the 24 hours after MPFL reconstruction in pediatric patients.”
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