50th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

#6736 Genicular nerve blocks for arthroscopic anterior cruciate ligament reconstruction surgery: a randomized controlled trial

Kim D1,2, Beathe J 1,2, Wetmore D 1,2, Allen A3,4, Nwachukwu B3,4, Williams R3,4, Nawabi D3,4, Sheetz M1, Tailor M1, Rowe J1, Puglisi A1, Popovic M1, Thor P1, Lauzadis J1, Liu J1,2

1Department of Anesthesiology, Critical Care, & Pain Management, Hospital for Special Surgery, 2Department of Anesthesiology, Weill Cornell Medicine, 3Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA, 4Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA

INTRODUCTION

The purpose of this study is to investigate the potential analgesic benefits of adding the genicular nerve block to our institutional standard regimen of peripheral nerve blocks for ACL surgery, which includes an adductor canal block (ACB) and interspace between the popliteal artery and capsule of the posterior knee block (IPACK).

METHODS

●Approved by Hospital for Special Surgery (HSS) Institutional Review Board (IRB #2022-1962) and registered on ClinicalTrials.Gov (NCT05720949)

●192 patients were enrolled and randomized to either the control group (ACB and IPACK blocks) or the intervention group (ACB, IPACK and Genicular blocks)

●191 patients were observed in the post anesthesia care unit (PACU) and contacted up to 7 days postoperatively and analyzed for primary outcome of opioid consumption during the first 24 hours

●Secondary outcomes included opioid consumption up to 7 days postoperatively, Numeric Rating Scale pain scores, satisfaction, adverse events, success and duration of analgesic blocks, readiness for discharge, and length of stay

RESULTS

Addition of the genicular nerve block to ACB and IPACK for ACL reconstruction surgery with bone-tendon-bone autograft significantly lowers pain at rest and opioid consumption in the PACU.

There were significantly more opioid-free patients over the study period (20% vs 8%, p = 0.035) in the intervention group.

●NRS pain at rest was significantly lower in the intervention group in the PACU (p=0.004).

●Patient satisfaction with pain management was significantly higher in the intervention group in the PACU (p=0.002) and 48 hours postoperatively (0.001).

DISCUSSION

Our results suggest that the genicular nerve block is a potentially effective modality to aid in the over reliance of opioid use for ambulatory surgery.

50th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

GENICULAR NERVE BLOCKS FOR ARTHROSCOPIC ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION SURGERY: A RANDOMIZED CONTROLLED TRIAL

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