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Wenning M, Sofack GN, Zöller D, Mauch M, Heitner AH, Paul J, Zahn P, Ritzmann R. Predicting the Recovery of Isokinetic Knee Strength 6 Months After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2024; 12:23259671241264845. [PMID: 39247527 PMCID: PMC11375688 DOI: 10.1177/23259671241264845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/02/2024] [Indexed: 09/10/2024] Open
Abstract
Background The limb symmetry index (LSI) is a metric of strength restoration. It is key to successfully return to sports after anterior cruciate ligament (ACL) reconstruction. The threshold for return to sports is generally considered an LSI of ≥85%. Purpose To develop a statistical model for predicting the recovery of knee extension and flexion strength (with LSI ≥85%) at 6 months after ACL reconstruction. Study Design Case-control study; Level of evidence: 3. Methods Patients who underwent arthroscopic ACL reconstruction between November 2015 and December 2020 were included. The patients were classified into 2 groups: "pass" if the LSI at 6 months postoperatively was ≥85% and "fail" if the LSI was <85%. Factors in 25 categories with 74 levels, including patient characteristics, periarticular procedures, intra-articular lesions and treatment, and perioperative management, were collected. A multivariable logistic regression combined with backward variable elimination was used to determine the predictive parameters for recovery of knee extension and flexion strength. Results A total of 948 patients were included. Graft site, preoperative isokinetic strength, treatment of meniscal injury, and injured side (left vs right) were identified as general predictors for both knee extension and flexion strength. For knee extension strength, age at injury and partial weightbearing duration were identified as additional predictors. For knee flexion strength, type of meniscal injury, surgeon volume, cartilage procedures, and periarticular procedures were identified as additional predictors. The Nagelkerke R 2 of the final model was 0.178, and the c-statistic was 0.716 (95% CI, 0.676-0.754). The Hosmer-Lemeshow test indicated good calibration (P = .879). Conclusion Several factors including preoperative isokinetic strength, treatment of meniscal injuries, left vs. right side and graft site were found to predict recovery of ≥85% LSI in knee extension and flexion strength. Despite the numerous factors that were analyzed, the predictive power was moderate (c-statistic = 0.716), indicating there were other nonincluded factors that significantly influence strength performance at 6 months postoperatively.
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Affiliation(s)
- Markus Wenning
- Department of Orthopaedic and Trauma Surgery, University Medical Center, Faculty of Medicine, University of Freiburg, Germany
- Orthopaedic Surgery, BDH Klinik Waldkirch, Waldkirch, Germany
| | - Ghislain N Sofack
- Institute of Medical Biometry and Statistics, Faculty of Medicine, University of Freiburg, Germany
| | - Daniela Zöller
- Institute of Medical Biometry and Statistics, Faculty of Medicine, University of Freiburg, Germany
| | - Marlene Mauch
- Praxisklinik Rennbahn, Basel, Switzerland
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | | | | | - Peter Zahn
- Department of Orthopaedic and Trauma Surgery, University Medical Center, Faculty of Medicine, University of Freiburg, Germany
| | - Ramona Ritzmann
- Praxisklinik Rennbahn, Basel, Switzerland
- Department of Sport and Sport Science, University of Freiburg, Germany
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Han Z, Zhang Y, Xue C, Jin S, Chen Q, Zhang Y. Comparison of the Effects of Adductor Canal and Femoral Nerve Blocks on Postoperative Opioid Consumption and Inflammatory Factor Levels in Elderly Patients After Total Knee Arthroplasty: A Prospective Observational Study. J Pain Res 2024; 17:2375-2391. [PMID: 39011277 PMCID: PMC11249107 DOI: 10.2147/jpr.s463097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 06/28/2024] [Indexed: 07/17/2024] Open
Abstract
Purpose Total Knee Arthroplasty (TKA) is a highly invasive procedure causing severe postoperative pain, which hampers early mobility. Effective pain management is crucial for optimal recovery. This study aimed to evaluate how adductor canal block (ACB) and femoral nerve block (FNB) affect opioid use and inflammation factor levels in elderly TKA patients. Methods This prospective observational study included 120 patients who received TKA, and divided them into three groups, based on the different nerve block technique: ACB, FNB, and no intervention before general anesthesia (CON). Postoperative opioid consumption, pain assessment, inflammation factor, knee function recovery and other clinical indicators were recorded. Results The CON group had significantly higher cumulative sufentanil consumption compared to the ACB and FNB groups at both 12 h and 48h postoperative (P<0.001). Compared with the CON group, the ACB and FNB groups persistently had lower pain scores until 12 h at rest and 24 h during motion after surgery. The ACB group showed significantly lower serum concentrations of C-reactive protein (CRP) and interleukin-6 (IL-6) compared to the CON group at 24 h postoperative (P=0.017, P=0.009), and IL-6 levels remained significantly lower at 72 h postoperative (P=0.005). Both ACB and FNB groups achieved earlier ambulation compared to the CON group (P=0.002). On the first day postoperative, both the ACB and FNB groups showed significantly better knee motion (P<0.001), quadriceps strength (P<0.001), and daily mobilization (P<0.001) compared to the CON group. Additionally, the ACB group exhibited superior quadriceps strength (P<0.001) and daily mobilization (P<0.001) compared to the FNB group. Conclusion The ACB and FNB groups exhibited comparable clinical efficacy outcomes in terms of pain scores and opioid consumption. However, the ACB group experienced reduced postoperative inflammation and improved knee recovery, especially in quadriceps strength.
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Affiliation(s)
- Zhengyi Han
- Department of Anesthesiology, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, People’s Republic of China
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, 230601, People’s Republic of China
| | - Yangyang Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, People’s Republic of China
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, 230601, People’s Republic of China
| | - Chenxi Xue
- Department of Orthopedics, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, People’s Republic of China
| | - Shiyun Jin
- Department of Anesthesiology, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, People’s Republic of China
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, 230601, People’s Republic of China
| | - Qi Chen
- Department of Anesthesiology, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, People’s Republic of China
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, 230601, People’s Republic of China
| | - Ye Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, People’s Republic of China
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, 230601, People’s Republic of China
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Kanayama T, Nakase J, Yoshimizu R, Ishida Y, Yanatori Y, Arima Y, Takemoto N. Periarticular cocktail injection is more useful than nerve blocks for pain management after anterior cruciate ligament reconstruction. Asia Pac J Sports Med Arthrosc Rehabil Technol 2024; 36:45-49. [PMID: 38584974 PMCID: PMC10995970 DOI: 10.1016/j.asmart.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 02/12/2024] [Accepted: 03/17/2024] [Indexed: 04/09/2024] Open
Abstract
Background Anterior cruciate ligament (ACL) reconstruction is commonly associated with moderate-to-severe postoperative pain. Notably, various pain control strategies, a femoral nerve block (FNB) with a lateral femoral cutaneous nerve block (LFCNB), adductor canal block (ACB) with LFCNB, or periarticular cocktail injection (PI), have been investigated. However, no studies compare the effects of FNB with LFCNB, ACB with LFCNB, and PI for pain control after ACL reconstruction. This study aimed to evaluate the impact of FNB with LFCNB, ACB with LFCNB, and PI for pain relief in the early postoperative period after ACL reconstruction. Methods This retrospective controlled clinical trial enrolled 299 patients who underwent primary ACL reconstruction at our hospital between April 2016 and October 2022. We categorized these cases into groups based on the use of PI (PI group), FNB with LFCNB (FNB group), and ACB with LFCNB (ACB group) for pain management. We selected 40 cases each, with matched age, sex, and body mass index (BMI) from each group, resulting in 120 cases for analysis. In the FNB and ACB groups, 0.75% ropivacaine 15 ml was injected under ultrasound guidance preoperatively. In the PI group, a mixture of 0.75% ropivacaine 20 ml, normal saline 20 ml, and dexamethasone 6.6 mg was injected half at the start of surgery and the rest just before wound closure. Patient demographics (age, sex, height, body weight, and BMI) and surgical data (the requirement for meniscal repair, operative time, and tourniquet inflation time) were analyzed. After ACL reconstruction, patients' numerical rating scale pain scores (NRS) (0-10) were recorded at 30 min and 4, 8, 12, 24, 48, and 72 h postoperatively. NRS were then compared among the three groups using analysis of variance. In addition, within each group, these data were compared between the NRS ≥7 and NRS ≤6 groups using a t-test. Results There were no significant differences in patient demographics and surgical data. Pain scores were significantly higher in the PI group than in the FCB and ACB groups 30 min postoperatively, but they were lower at 12, 24, 48, and 72 h postoperatively. In the FNB group, there were no significant differences in the demographic and surgical data by NRS pain score. In the ACB group, the number of men was significantly higher in the NRS ≥7 group than in the NRS ≤6 group (p = 0.015). In the PI group, tourniquet inflation time was significantly longer in the NRS ≥7 group than in the NRS ≤6 group (p = 0.008). Conclusions Following ACL reconstruction using a hamstring autograft, periarticular cocktail significantly reduced early postoperative pain compared with nerve block combinations.
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Affiliation(s)
- Tomoyuki Kanayama
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Junsuke Nakase
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Rikuto Yoshimizu
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Yoshihiro Ishida
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Yusuke Yanatori
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Yu Arima
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Naoki Takemoto
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
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Zhang T, Zhang T, Niu X, Li L, Gu J, Chen M, Zhao X. Femoral nerve block using lower concentration ropivacaine preserves quadriceps strength while providing similar analgesic effects after knee arthroscopy. Knee Surg Sports Traumatol Arthrosc 2023; 31:4988-4995. [PMID: 37638985 PMCID: PMC10598127 DOI: 10.1007/s00167-023-07549-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/10/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE Femoral nerve block (FNB) is widely used in patients undergoing knee arthroscopy. However, the most commonly used concentration of ropivacaine (0.2% or above) may cause an unexpected decrease in the muscle strength of the quadriceps. Therefore, a lower concentration of ropivacaine (0.1%) for FNB was administered to investigate the effect on quadriceps strength and postoperative pain after knee arthroscopy. METHODS This was a double-blind, randomized, controlled trial (ChiCTR2000041404). A total of 83 patients scheduled for elective knee arthroscopy were randomized to receive 0.1% or 0.2% ropivacaine for FNB under ultrasound guidance. The primary outcomes were quadriceps strength and numerical rating scale (NRS) pain score. Quadriceps strength was measured before surgery and 6 h and 24 h after surgery, while NRS score was recorded before surgery, at the postanaesthesia care unit (PACU), and 6 h and 24 h after surgery. Multiple linear regression tests were used to compare the differences in quadriceps strength and NRS score between the two groups. Two-factor analysis of variance, using the factors group and time of measurement, was used for repeated NRS scores. Secondary outcomes included knee mobility, side effects, patient satisfaction, and length of hospital stay. RESULTS The mean (SD) quadriceps strength at 6 h after surgery was 7.5 (5.7) kg for the 0.1% ropivacaine group and 3.0 (4.4) kg for the 0.2% ropivacaine group. The mean difference adjusted for baseline characteristics was - 5.2 (95% CI - 7.2 to - 3.1) kg (P < 0.001). There was no significant difference between the two groups in quadriceps strength at 24 h after surgery. The mean differences in the average NRS score and maximum NRS score in the PACU were - 0.6 (P = 0.008) and - 1.0 (P < 0.001), respectively. There was no significant difference in NRS score at 6 h or 24 h after surgery. Two-factor analysis of variance showed no significant difference in the interaction factors of time and group for average NRS score and maximum NRS score. CONCLUSIONS Compared with 0.2% ropivacaine, 0.1% ropivacaine for FNB preserved quadriceps strength at 6 h after knee arthroscopy while providing similar analgesic effects. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Tao Zhang
- Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Tingting Zhang
- Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaoyin Niu
- Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lantao Li
- Department of Anesthesiology, Sichuan Cancer Hospital and Institute, University of Electronic Science and Technology of China, Chengdu, China
| | - Jiaji Gu
- Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Minghui Chen
- Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xuan Zhao
- Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
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Oshima T, Nakase J, Kanayama T, Yanatori Y, Ishida T, Tsuchiya H. Ultrasound-guided adductor canal block is superior to femoral nerve block for early postoperative pain relief after single-bundle anterior cruciate ligament reconstruction with hamstring autograft. J Med Ultrason (2001) 2023; 50:433-439. [PMID: 37106246 DOI: 10.1007/s10396-023-01309-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/22/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE This study aimed to compare the combination of a lateral femoral cutaneous nerve (LFCN) block with a femoral nerve block (FNB) and an adductor canal block (ACB) for postoperative pain control in patients undergoing anterior cruciate ligament (ACL) reconstruction with hamstring autograft. METHODS A non-randomized, prospective, controlled clinical trial was conducted. The FNB and ACB groups consisted of 41 and 40 patients, respectively. Thirty minutes prior to surgery, the patients received an ultrasound-guided LFCN block either with FNB or ACB. The following values were recorded and compared between the two groups: duration of surgery, pain management during surgery (including total amount of fentanyl administered), and numerical rating scale (NRS) scores at 30 min and 4, 8, 12, 24, 48, and 72 h after surgery. Factors affecting pain relief (NRS < 2) were evaluated, including block type, total amount of fentanyl administered, duration of surgery, age, sex, body mass index, and postoperative suppository use. Significant factors predicting pain relief were determined using the Cox proportional hazard regression model. RESULTS There were no significant differences in pain management during the surgery. Pain scores were significantly lower in the ACB group at 30 min, 4 h, 24 h, and 48 h after surgery. The Cox proportional hazard regression model identified ACB as a significant factor for pain relief (hazard ratio: 1.88; 95% confidence interval: 1.12-3.13; p = 0.018). CONCLUSION The combination of ACB with LFCN block during ACL reconstruction significantly reduced pain in the early postoperative period compared to FNB with LFCN block.
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Affiliation(s)
- Takeshi Oshima
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazaw, Ishikawa, 920-8641, Japan
- Asanogawa General Hospital, Kanazawa, Ishikawa, Japan
| | - Junsuke Nakase
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazaw, Ishikawa, 920-8641, Japan.
| | - Tomoyuki Kanayama
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazaw, Ishikawa, 920-8641, Japan
| | - Yusuke Yanatori
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazaw, Ishikawa, 920-8641, Japan
| | - Toshihiro Ishida
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazaw, Ishikawa, 920-8641, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazaw, Ishikawa, 920-8641, Japan
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Yusupov A, Fasulo SM, Dávila Castrodad IM, Kraeutler MJ, Scillia AJ. Improved Pain and Perioperative Outcomes After Hip Arthroscopy With the Pericapsular Nerve Group Block. Arthroscopy 2023; 39:293-297. [PMID: 36183920 DOI: 10.1016/j.arthro.2022.08.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/20/2022] [Accepted: 08/22/2022] [Indexed: 02/09/2023]
Abstract
PURPOSE To compare early postoperative pain in patients undergoing hip arthroscopy with versus without the pericapsular nerve group (PENG) block. METHODS A retrospective chart review of prospectively collected data was performed to identify patients who underwent hip arthroscopy at a single institution between May 2019 and October 2021. Patients were included if they received general anesthesia and were opioid naive. Patients who received the PENG block were compared with patients who did not. Opioid, benzodiazepine, and antiemetic medication administration was recorded both intraoperatively and for the duration of the patient's stay in the postanesthesia care unit (PACU). Opioids administered were converted to morphine milligram equivalents (MMEs). Pain was assessed with a visual analog scale. Time to discharge (in minutes) and complications were recorded. RESULTS A total of 53 patients were identified for inclusion, of whom 28 received the PENG block and 25 did not. Opioid consumption was significantly lower in the PENG block group both intraoperatively (16.9 ± 14.1 MMEs vs 40.6 ± 18.3 MMEs, P < .001) and in the PACU (14.4 ± 11.4 MMEs vs 31.2 ± 20.1 MMEs, P < .001). The highest recorded PACU pain score was significantly greater in the no-PENG block group (7.0 ± 1.9 vs 5.3 ± 2.1, P = .004). Within the PENG block group, fewer patients required antiemetics (0 vs 4, P = .043). There was a greater time to discharge in the no-PENG block group (161 ± 50 minutes vs 129 ± 34 minutes, P = .008). No complications, including postoperative falls, were noted in either group. CONCLUSIONS The PENG block improves perioperative outcomes by decreasing pain, opioid consumption, time to discharge, antiemetic requirements, and benzodiazepine requirements after hip arthroscopy. LEVEL OF EVIDENCE Level III, retrospective comparative therapeutic trial.
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Affiliation(s)
- Albert Yusupov
- Morristown Medical Center, Morristown, New Jersey, U.S.A
| | - Sydney M Fasulo
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey, U.S.A
| | - Iciar M Dávila Castrodad
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey, U.S.A
| | - Matthew J Kraeutler
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey, U.S.A
| | - Anthony J Scillia
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey, U.S.A..
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Fan Chiang YH, Wang MT, Chan SM, Chen SY, Wang ML, Hou JD, Tsai HC, Lin JA. Motor-Sparing Effect of Adductor Canal Block for Knee Analgesia: An Updated Review and a Subgroup Analysis of Randomized Controlled Trials Based on a Corrected Classification System. Healthcare (Basel) 2023; 11:210. [PMID: 36673579 PMCID: PMC9859112 DOI: 10.3390/healthcare11020210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 12/28/2022] [Accepted: 12/31/2022] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Discrepancies in the definition of adductor canal block (ACB) lead to inconsistent results. To investigate the actual analgesic and motor-sparing effects of ACB by anatomically defining femoral triangle block (FTB), proximal ACB (p-ACB), and distal ACB (d-ACB), we re-classified the previously claimed ACB approaches according to the ultrasound findings or descriptions in the corresponding published articles. A meta-analysis with subsequent subgroup analyses based on these corrected results was performed to examine the true impact of ACB on its analgesic effect and motor function (quadriceps muscle strength or mobilization ability). An optimal ACB technique was also suggested based on an updated review of evidence and ultrasound anatomy. MATERIALS AND METHODS We systematically searched studies describing the use of ACB for knee surgery. Cochrane Library, PubMed, Web of Science, and Embase were searched with the exclusion of non-English articles from inception to 28 February 2022. The motor-sparing and analgesic aspects in true ACB were evaluated using meta-analyses with subsequent subgroup analyses according to the corrected classification system. RESULTS The meta-analysis includes 19 randomized controlled trials. Compared with the femoral nerve block group, the quadriceps muscle strength (standardized mean difference (SMD) = 0.33, 95%-CI [0.01; 0.65]) and mobilization ability (SMD = -22.44, 95%-CI [-35.37; -9.51]) are more preserved in the mixed ACB group at 24 h after knee surgery. Compared with the true ACB group, the FTB group (SMD = 5.59, 95%-CI [3.44; 8.46]) has a significantly decreased mobilization ability at 24 h after knee surgery. CONCLUSION By using the corrected classification system, we proved the motor-sparing effect of true ACB compared to FTB. According to the updated ultrasound anatomy, we suggested proximal ACB to be the analgesic technique of choice for knee surgery. Although a single-shot ACB is limited in duration, it remains the candidate of the analgesic standard for knee surgery on postoperative day 1 or 2 because it induces analgesia with less motor involvement in the era of multimodal analgesia. Furthermore, data from the corrected classification system may provide the basis for future research.
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Affiliation(s)
- Yu-Hsuan Fan Chiang
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei 11031, Taiwan
| | - Ming-Tse Wang
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei 11031, Taiwan
| | - Shun-Ming Chan
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei 11490, Taiwan
| | - Se-Yi Chen
- Department of Neurosurgery, Chung-Shan Medical University Hospital, Taichung 40201, Taiwan
- School of Medicine, Chung-Shan Medical University, Taichung 40201, Taiwan
| | - Man-Ling Wang
- Department of Anesthesiology, National Taiwan University Hospital, Taipei 100225, Taiwan
| | - Jin-De Hou
- Division of Anesthesiology, Hualien Armed Forces General Hospital, Hualien 97144, Taiwan
- Department of Anesthesiology, School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan
| | - Hsiao-Chien Tsai
- Dianthus MFM Clinic Taoyuan, Dianthus MFM Center, Taoyuan 33083, Taiwan
| | - Jui-An Lin
- Department of Anesthesiology, School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Center for Regional Anesthesia and Pain Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Department of Anesthesiology, School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Anesthesiology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
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Wenning M, Mauch M, Heitner AH, Heinrich S, Sofack GN, Behrens M, Ritzmann R. General, spinal or regional anaesthesia does not affect strength performance 6 months after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2023; 31:487-494. [PMID: 35908113 PMCID: PMC9898431 DOI: 10.1007/s00167-022-07052-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/09/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE The recovery of strength is a key element in successfully returning to sports after ACL reconstruction. The type of anaesthesia has been suspected an influential factor in the post-operative recovery of muscle function. METHODS In this retrospective analysis, n = 442 consecutive patients undergoing primary isolated ACL reconstruction using a hamstring autograft were analysed by pre- and post-operative isokinetic tests in a single orthopaedic centre. These were subdivided into four cohorts: (1) general anaesthesia (n = 47), (2) general anaesthesia with prolonged (48 h) on-demand femoral nerve block (n = 37), (3) spinal anaesthesia (n = 169) and (4) spinal anaesthesia with prolonged (48 h) on-demand femoral nerve block (n = 185). Primary outcome was the change from pre- to post-operative isokinetic strength during knee extension and flexion. RESULTS Using one-way ANOVA, there was no significant influence of the type of anaesthesia. The main effect of anaesthesia on change in extension forces was not significant, and effect sizes were very small (n.s.). Similarly, the main effect of anaesthesia on change in flexion forces was statistically not significant (n.s.). CONCLUSIONS The findings of this study support the interpretation that the type of anaesthesia has no significant effect on the ability to recover thigh muscle strength 6 months after isolated hamstring ACL reconstruction. With regard to the recovery of athletic performance and return-to-sports testing criteria, there is no reason to avoid regional anaesthesia. LEVEL OF EVIDENCE III.
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Affiliation(s)
- M. Wenning
- Rennbahnklinik, Muttenz, Basel, Switzerland ,Department of Orthopedic and Trauma Surgery, Faculty of Medicine, University Medical Center, University of Freiburg, Hugstetter Str. 55, 79104 Freiburg, Germany
| | - M. Mauch
- Department of Biomechanics, Rennbahnklinik, Kriegackerstrasse 100, Muttenz, CH-4132, Basel, Switzerland
| | | | - S. Heinrich
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, University Medical Center, University of Freiburg, Freiburg, Germany
| | - G. N. Sofack
- Institute of Medical Biometry and Statistics, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - M. Behrens
- Institute of Medical Biometry and Statistics, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - R. Ritzmann
- Rennbahnklinik, Muttenz, Basel, Switzerland ,Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany
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Crutchfield CR, Schweppe EA, Padaki AS, Steinl GK, Roller BA, Brown AR, Lynch TS. A Practical Guide to Lower Extremity Nerve Blocks for the Sports Medicine Surgeon. Am J Sports Med 2023; 51:279-297. [PMID: 35437023 DOI: 10.1177/03635465211051757] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Peripheral nerve blocks (PNBs) are vital in the administration of surgical analgesia and have grown in popularity for use in lower extremity arthroscopic procedures because of their capacity to safely and effectively control pain. The number and specificity of PNBs, however, have made choosing the best option for a procedure nebulous for orthopaedic surgeons. PURPOSE To present a narrative literature review of the PNBs available for arthroscopic hip and knee procedures that is adapted to an audience of orthopaedic surgeons. STUDY DESIGN Narrative literature review. METHODS A combination of the names of various lower extremity PNBs AND "hip arthroscopy" OR "knee arthroscopy" was used to search the English medical literature including PubMed, Cochrane Library, ScienceDirect, Embase, and Scopus. Placement technique, specificity of blockade, efficacy, and complications were assessed. Searches were performed through May 2, 2021. RESULTS A total of 157 studies were included in this review of lower extremity PNBs. Femoral nerve, lumbar plexus, sciatic nerve, and fascia iliaca compartment blocks were most commonly used in arthroscopic hip surgery, while femoral nerve, 3-in-1, and adductor canal blocks were preferred for arthroscopic knee surgery. Each block demonstrated a significant benefit (P > .05) in ≥1 of the following outcomes: intraoperative morphine, pain scores, nausea, and/or opioid consumption. Combination blocks including the lateral femoral cutaneous nerve block, obturator nerve block, quadratus lumborum block, and L1 and L2 paravertebral block have also been described. Complication rates ranged from 0% to 4.8% in those administered with ultrasound guidance. The most commonly reported complications included muscular weakness, postoperative falls, neuropathy, intravascular and intraneural injections, and hematomas. CONCLUSION When administered properly, PNBs were a safe and effective adjuvant method of pain control with a significant potential to limit postoperative narcotic use. While blockade choice varies by surgeon preference and procedure, all PNBs should be administered with ultrasound guidance, and vigilant protocols for the risk of postoperative falls should be exercised in patients who receive them.
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Affiliation(s)
| | - Eric A Schweppe
- Columbia University Irving Medical Center, New York, New York, USA
| | - Ajay S Padaki
- Columbia University Irving Medical Center, New York, New York, USA
| | | | - Brian A Roller
- Columbia University Irving Medical Center, New York, New York, USA
| | - Anthony R Brown
- Columbia University Irving Medical Center, New York, New York, USA
| | - T Sean Lynch
- Columbia University Irving Medical Center, New York, New York, USA
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10
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Tang X, Jiang X, Lei L, Zhu W, Fu Z, Wang D, Chen J, Ning N, Zhou Z. IPACK (Interspace between the Popliteal Artery and the Capsule of the Posterior Knee) Block Combined with SACB (Single Adductor Canal Block) Versus SACB for Analgesia after Total Knee Arthroplasty. Orthop Surg 2022; 14:2809-2821. [PMID: 36125191 DOI: 10.1111/os.13263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/10/2022] [Accepted: 03/21/2022] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To evaluate the combination of the infiltration between the popliteal artery and the posterior capsule of the knee (iPACK) block and single adductor canal block (SACB) versus SACB for motor-sparing knee analgesia effects after total knee arthroplasty (TKA). METHODS PubMed, Ovid, Cochrane Library, and other databases were searched from the inception to January 2021. Randomized controlled trials (RCTs) comparing patients receiving iPACK plus SACB with patients receiving SACB after TKA were included. The included studies were assessed by two reviewers according to the Cochrane risk of bias criteria. Meta-analysis was performed with STATA 13.0 software, the risk ratios (RR) and mean differences (MD) were used to compare dichotomous and continuous variables. The primary outcome was ambulation pain and secondary outcomes were rest pain, opioid consumption, function ability, clinical outcomes, and complications. RESULTS Seven RCTs (304 knees in iPACK + SACB group; 305 knees in SACB group) were included. The follow-up periods ranged from 2 days to 3 months. Pooled data indicated lower pain scores at ambulation (p < 0.0001) for iPACK + SACB. When comparing the pain scores of subgroups analyzed at specific periods, lower scores in subgroups within 12 h (at rest and ambulation) and after 48 h (at ambulation) were observed in the iPACK + SACB group. Analysis demonstrated greater reduction in morphine consumption (p = 0.007) in the iPACK + SACB group. The iPACK + SACB group is also superior to the SACB group regarding function ability, which included range of motion (ROM) (p = 0.001), time up to go (TUG) test (p = 0.030), and ambulation distance (p < 0.0001). No difference was found in clinical outcomes or complications. CONCLUSIONS With the iPACK added to SACB, pain scores, morphine consumption, functional ability were improved. Additional high-quality studies are required to further address this topic.
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Affiliation(s)
- Xiumei Tang
- West China School of Nursing, Sichuan University/Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Xile Jiang
- Department of Clinical Nutrition, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Lei Lei
- West China School of Nursing, Sichuan University/Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Weitao Zhu
- Department of Computer Science and Technology, Sichuan University, Chengdu, P.R. China
| | - Zhongmin Fu
- West China School of Nursing, Sichuan University/Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Duan Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Jiali Chen
- West China School of Nursing, Sichuan University/Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Ning Ning
- West China School of Nursing, Sichuan University/Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Zongke Zhou
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, P.R. China
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11
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Dixit A, Prakash R, Yadav AS, Dwivedi S. Comparative Study of Adductor Canal Block and Femoral Nerve Block for Postoperative Analgesia After Arthroscopic Anterior Cruciate Ligament Tear Repair Surgeries. Cureus 2022; 14:e24007. [PMID: 35547414 PMCID: PMC9090210 DOI: 10.7759/cureus.24007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2022] [Indexed: 11/05/2022] Open
Abstract
Objective: The study aimed to compare an adductor canal block (ACB) with a femoral nerve block (FNB) with regard to their analgesic efficacy and the quadriceps muscle strength in patients following arthroscopic anterior cruciate ligament (ACL) tear repair surgeries. Materials and Methods: Ninety patients in the American Society of Anaesthesiologists (ASA) status I or II undergoing arthroscopic ACL tear repair surgeries under subarachnoid block were divided into three groups to receive ACB (Group ACB), FNB (Group FNB), and control (Group C). Each patient was assessed for Visual Analogue Scale (VAS) score, tramadol consumption, and quadriceps muscle strength postoperatively in the post anaesthesia care unit (PACU). Results: There was no significant difference between the Group ACB and Group FNB regarding postoperative analgesia and total rescue analgesic consumption at 24 hrs postoperative. The mean VAS score at two, four, and six hours and total rescue analgesic consumption in 24 hrs were higher in the control group, which was statistically significant (p-value <0.05). Quadriceps muscle strength by straight leg raise test was significantly higher in the Group ACB compared with the Group FNB at 0, 6, 12, 18 hours postoperatively (p-value <0.0001), whereas the difference between both study groups become statistically insignificant at 24 hours postoperative. Conclusion: ACB preserved quadriceps muscle strength better than FNB, without a significant difference in postoperative analgesia after arthroscopic ACL tear repair surgeries.
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12
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Luo W, Liang J, Wu J, Luo Q, Wu H, Ou Y, Li Y, Ma W. Effects of pericapsular nerve group (PENG) block on postoperative recovery in elderly patients with hip fracture: study protocol for a randomised, parallel controlled, double-blind trial. BMJ Open 2022; 12:e051321. [PMID: 35351697 PMCID: PMC8966559 DOI: 10.1136/bmjopen-2021-051321] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Hip fracture is a common and serious emergency in the elderly, and it is associated with severe pain, significant morbidity and mortality. The use of peripheral nerve block can relieve pain effectively and reduce opioid requirements, which may accelerate patient's recovery. The pericapsular nerve group (PENG) block has been found to provide an effective blockade to the hip joint with a potential motor-sparing effect, so we hypothesised that the PENG block may be an effective tool to enhance the recovery in elderly patients after hip fracture surgery. METHODS AND ANALYSIS This study is a single-centred, randomised, parallel controlled, double-blind trial. A total of 92 elderly patients scheduled for hip fracture surgery will be divided into two groups at random to receive either ultrasound-guided femoral nerve block or ultrasound-guided PENG block. The primary outcome will be to compare the Quality of Recovery-15 scores at 24 hours postoperatively between the two groups. The secondary outcomes will include measuring and comparing the strength of the quadriceps, the visual analogue scale at rest and on movement, the total morphine consumption, the rescue analgesic, the first time of postoperative out-of-bed mobilisation and complications. ETHICS AND DISSEMINATION This study was approved by the Institutional Review Board of the Ethics Committee of The First Affiliated Hospital of Guangzhou University of Chinese Medicine on 15 December 2020 (reference K2020-110). The results of this study will be published in peer-reviewed international journals. TRIAL REGISTRATION NUMBER ChiCTR2100042341.
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Affiliation(s)
- Wei Luo
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jianhui Liang
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jieting Wu
- Department of Anesthesiology, The Third People's Hospital of Guangzhou Baiyun District, Guangzhou, Guangdong, China
| | - Quehua Luo
- Department of Anesthesiology, Guangdong Provincial People's Hospital, and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Huiyi Wu
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yanhua Ou
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yuhui Li
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - WuHua Ma
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
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13
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DeMaio EL, Hunnicutt JL, Haley RM, Nazzal E, Chen Y, Premkumar A, Lamplot JD, Samady HA, Gottschalk MB, Xerogeanes JW. Liposomal Bupivacaine and Ropivacaine Adductor Canal Blocks for Anterior Cruciate Ligament Reconstruction Provide Similar Postoperative Analgesia. J Knee Surg 2022. [PMID: 35272368 DOI: 10.1055/s-0042-1743235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of this study was to compare postoperative pain following anterior cruciate ligament (ACL) reconstruction (ACLR) in patients receiving an adductor canal block (ACB) with ropivacaine (R-ACB) or liposomal bupivacaine (LB-ACB). The secondary purpose was to compare opioid consumption. A prospective cohort study of patients undergoing ACLR at an academic medical center was conducted from November 1, 2018 to November 21, 2019. The first cohort received R-ACB and 30 tablets of 5/325 mg oxycodone/acetaminophen. After June 13, 2019, the second cohort received LB-ACB and 20 tablets of 5/325 mg oxycodone/acetaminophen with the reduction in opioids prescribed resulting from a hospital quality improvement initiative to decrease narcotic consumption. From postoperative days 0 through 6, pain was assessed thrice daily using a numeric rating scale. Total postoperative opioid consumption was reported via tablet count and converted to oral morphine equivalents (OMEs). During this period, 165 subjects underwent ACLR, and 126 met the eligibility criteria (44.4% female, 55.6% male; mean ± standard deviation: 28.7 ± 13.7 years). Sixty-six (52.4%) received LB-ACB, and 60 (47.6%) received R-ACB (p = 0.53). The most common graft utilized was quadriceps autograft (63.6% LB-ACB; 58.3% R-ACB, p = 0.76). Mean postoperative pain scores were similar between groups during the entire postoperative period (p ≥ 0.08 for POD 0-6). While postoperative opioid consumption was lower among patients receiving LB-ACB (median OME [interquartile range]: 28.6 [7.5-63.8] vs. 45.0 [15.0-75.0], p = 0.023), this only amounted to an average of 2.2 tablets. Patients receiving LB-ACB in the setting of ACLR reported similar postoperative pain compared with those receiving R-ACB. Despite the second aim of our study, we cannot make conclusions about the effect of each block on opioid consumption given that each cohort received different numbers of opioid tablets due to institutional pressure to reduce opioid prescribing. As few patients completed their opioid prescriptions or requested refills, further reduction in prescription size is warranted. Future studies are necessary to further elucidate the effect of LB-ACB versus R-ACB on postoperative pain and opioid consumption after ACLR.
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Affiliation(s)
- Emily L DeMaio
- Department of Orthopaedic Surgery, Division of Sports Medicine, Emory University, Atlanta, Georgia
| | - Jennifer L Hunnicutt
- Department of Orthopaedic Surgery, Division of Sports Medicine, Emory University, Atlanta, Georgia
| | - Rebecca M Haley
- Department of Orthopaedic Surgery, Division of Sports Medicine, Emory University, Atlanta, Georgia
| | - Ehab Nazzal
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Yunyun Chen
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Ajay Premkumar
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Joseph D Lamplot
- Department of Orthopaedic Surgery, Division of Sports Medicine, Emory University, Atlanta, Georgia
| | - Heather A Samady
- Department of Orthopaedic Surgery, Division of Sports Medicine, Emory University, Atlanta, Georgia
| | - Michael B Gottschalk
- Department of Orthopaedic Surgery, Division of Sports Medicine, Emory University, Atlanta, Georgia
| | - John W Xerogeanes
- Department of Orthopaedic Surgery, Division of Sports Medicine, Emory University, Atlanta, Georgia
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14
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Kamel I, Ahmed MF, Sethi A. Regional anesthesia for orthopedic procedures: What orthopedic surgeons need to know. World J Orthop 2022; 13:11-35. [PMID: 35096534 PMCID: PMC8771411 DOI: 10.5312/wjo.v13.i1.11] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/20/2021] [Accepted: 01/10/2022] [Indexed: 02/06/2023] Open
Abstract
Regional anesthesia is an integral component of successful orthopedic surgery. Neuraxial anesthesia is commonly used for surgical anesthesia while peripheral nerve blocks are often used for postoperative analgesia. Patient evaluation for regional anesthesia should include neurological, pulmonary, cardiovascular, and hematological assessments. Neuraxial blocks include spinal, epidural, and combined spinal epidural. Upper extremity peripheral nerve blocks include interscalene, supraclavicular, infraclavicular, and axillary. Lower extremity peripheral nerve blocks include femoral nerve block, saphenous nerve block, sciatic nerve block, iPACK block, ankle block and lumbar plexus block. The choice of regional anesthesia is a unanimous decision made by the surgeon, the anesthesiologist, and the patient based on a risk-benefit assessment. The choice of the regional block depends on patient cooperation, patient positing, operative structures, operative manipulation, tourniquet use and the impact of post-operative motor blockade on initiation of physical therapy. Regional anesthesia is safe but has an inherent risk of failure and a relatively low incidence of complications such as local anesthetic systemic toxicity (LAST), nerve injury, falls, hematoma, infection and allergic reactions. Ultrasound should be used for regional anesthesia procedures to improve the efficacy and minimize complications. LAST treatment guidelines and rescue medications (intralipid) should be readily available during the regional anesthesia administration.
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Affiliation(s)
- Ihab Kamel
- Department of Anesthesiology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, United States
| | - Muhammad F Ahmed
- Department of Anesthesiology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, United States
| | - Anish Sethi
- Department of Anesthesiology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, United States
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15
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Mousavibaygei S, Gerami M, Haghi F, Pelarak F. Anterior cruciate ligament (ACL) injuries: A review on the newest reconstruction techniques. J Family Med Prim Care 2022; 11:852-856. [PMID: 35495824 PMCID: PMC9051673 DOI: 10.4103/jfmpc.jfmpc_1227_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/09/2021] [Accepted: 11/10/2021] [Indexed: 11/04/2022] Open
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16
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Smith JRH, Kraeutler MJ, Keeling LE, Scillia AJ, McCarty EC, Mei-Dan O. Fascia Iliaca Block for Postoperative Pain Control After Hip Arthroscopy: A Systematic Review of Randomized Controlled Trials. Am J Sports Med 2021; 49:4042-4049. [PMID: 33710936 DOI: 10.1177/0363546521996713] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Various analgesic modalities have been used to improve postoperative pain in patients undergoing hip arthroscopy. PURPOSE To systematically review the literature to compare the efficacy of the fascia iliaca block (FIB) with that of other analgesic modalities after hip arthroscopy in terms of postoperative pain scores and analgesic consumption. STUDY DESIGN Systematic review. METHODS A systematic review was performed by searching PubMed, the Cochrane Library, and Embase up to April 2020 to identify randomized controlled trials that compared postoperative pain and analgesic consumption in patients after hip arthroscopy with FIB versus other pain control modalities. The search phrase used was "hip arthroscopy fascia iliaca randomized." Patients were evaluated based on postoperative pain scores and total postoperative analgesic consumption. RESULTS Five studies (3 level 1, 2 level 2) were identified that met inclusion criteria, including 157 patients undergoing hip arthroscopy with FIB (mean age, 38.3 years; 44.6% men) and 159 patients among the following comparison groups: lumbar plexus block (LPB), intra-articular ropivacaine (IAR), local anesthetic infiltration (LAI), saline placebo, and a no-block control group (overall mean age, 36.2 years; 36.5% men). No significant differences in pain scores were reported in the postanesthesia care unit (PACU) between the FIB and LPB (3.4 vs 2.9; P = .054), IAR (7.7 vs 7.9; P = .72), control group (no FIB: 4.1 vs 3.8; P = .76); or saline placebo (difference, -0.2 [95% CI, -1.1 to 0.7]). One study reported significantly higher pain scores at 1 hour postoperation in the FIB group compared with the LAI group (5.5 vs 3.4; P = .02). Another study reported significantly greater total analgesic consumption (in morphine equivalent dosing) in the PACU among the FIB group compared with the LPB group (20.8 vs 17.0; P = .02). No significant differences were observed in total PACU analgesic consumption between FIB and other analgesic modalities. CONCLUSION In patients undergoing hip arthroscopy, the FIB does not appear to demonstrate superiority to other forms of analgesics in the immediate postoperative period. Therefore, it is not recommended as a routine form of pain control for these procedures.
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Affiliation(s)
| | - Matthew J Kraeutler
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey, USA
| | - Laura E Keeling
- Department of Orthopaedics, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Anthony J Scillia
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey, USA.,New Jersey Orthopaedic Institute, Wayne, New Jersey, USA
| | - Eric C McCarty
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Omer Mei-Dan
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
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17
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Jaremko I, Lukaševič K, Tarasevičius Š, Zeniauskas L, Macas A, Gelmanas A. Comparison of 2 Peripheral Nerve Blocks Techniques for Functional Recovery and Postoperative Pain Management After Total Knee Arthroplasty: A Prospective, Double-Blinded, Randomized Trial. Med Sci Monit 2021; 27:e932848. [PMID: 34629461 PMCID: PMC8518512 DOI: 10.12659/msm.932848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Methods of pain management that have less effect on motor function after total knee arthroplasty (TKA) are needed to ensure early mobilization. We investigated whether the distal femoral triangle and distal adductor canal blocks are superior to the femoral nerve block regarding motor blockade at early postoperative hours. MATERIAL AND METHODS Patients scheduled for TKA under spinal anesthesia were blindly assigned into 2 groups. One group received the distal femoral triangle and distal adductor canal blocks and the other group received the femoral nerve block. In both groups, at 3, 6, 24, and 48 h after surgery motor blockade was evaluated with the Bromage scale. Secondary outcomes such as pain control efficacy and patient satisfaction were evaluated at 6, 24, and 48 h postoperatively using either the VAS scale or a 10-point scale. RESULTS We analyzed the outcomes of 77 patients. Better motor function at 3 and 6 h after TKA was observed in the distal femoral triangle and the distal adductor canal blocks group (37.7% vs 23.4%, p=0.032 and 49.4% vs 32.5%, p=0.002, respectively). At 24 h after the surgery, patients from the femoral nerve block group consumed significantly more rescue opioid analgesics (p=0.016). We found no significant differences in pain intensity and patient satisfaction at any timepoints after the surgery. CONCLUSIONS The distal femoral triangle and distal adductor canal blocks resulted in significantly better motor function at the first 3 and 6 h after total knee arthroplasty. At 24 h after surgery, rescue opioid doses in the femoral nerve block group were significantly higher.
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Affiliation(s)
- Inna Jaremko
- Department of Anesthesiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Karina Lukaševič
- Department of Anesthesiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Šarūnas Tarasevičius
- Department of Orthopaedics and Traumatology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Linas Zeniauskas
- Department of Orthopaedics and Traumatology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Andrius Macas
- Department of Anesthesiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Arūnas Gelmanas
- Department of Anesthesiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Frazer AR, Chaussé ME, Held M, St-Pierre C, Tsai CY, Preuss R, Descoteaux N, Chan M, Martineau PA, Veilleux LN. Quadriceps and Hamstring Strength in Adolescents 6 Months After ACL Reconstruction With Femoral Nerve Block, Adductor Canal Block, or No Nerve Block. Orthop J Sports Med 2021; 9:23259671211017516. [PMID: 34368383 PMCID: PMC8312176 DOI: 10.1177/23259671211017516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/09/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Femoral nerve block (FNB) and adductor canal block (ACB) have been used increasingly for pain control during anterior cruciate ligament (ACL) reconstruction in adolescent patients. However, recent evidence suggests that the use of FNB may affect quadriceps strength recovery 6 months after surgery. Purpose/Hypothesis: To compare postoperative isokinetic strength in adolescents who received FNB, ACB, or no block for perioperative analgesia during ACL reconstruction. We anticipated lower postoperative quadriceps and hamstring isokinetic deficits in adolescents who received FNB as compared with ACB. Study Design: Cohort study; Level of evidence, 3. Methods: Patients were included in the study if they had undergone hamstring tendon autograft ACL reconstruction by a single surgeon from July 2008 to January 2018 and if they underwent isokinetic muscle testing at 4 to 8 months postoperatively. The participants were divided into 3 groups (no block, FNB, and ACB), and we compared the deficit in percentages between the affected and unaffected limbs as calculated from the isokinetic quadriceps and hamstring strength testing at 60 and 180 deg/s. Between-group analysis was performed using analysis of variance, with an alpha of .05. Results: A total of 98 participants were included in the analysis (31 no block, 36 FNB, and 31 ACB). The mean ± SD age of the patients was 15.26 ± 1.15, 15.50 ± 1.42, and 15.71 ± 1.44, for no block, FNB, and ACB, respectively. At 5.61 months postoperatively, there was no significant difference across the 3 groups in isokinetic quadriceps deficits (P ≥ .99), and the only significant difference in isokinetic hamstring deficit was observed for peak flexion at 180 deg/s, in which the ACB group had lower peak torque than the FNB group (–9.80% ± 3.48% vs 2.37% ± 3.23%; P = .035). The ratio of participants with a deficit exceeding 15% did not differ significantly among the 3 groups. Conclusion: Contrary to previous research, our findings indicate only minimal difference in quadriceps strength among the 3 types of perioperative analgesia in adolescents approximately 6 months after ACL reconstruction. The only significant strength deficit was seen in the hamstrings of patients receiving ACB at peak flexion as compared with those receiving FNB.
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Affiliation(s)
- Abigail R Frazer
- Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Marie-Eve Chaussé
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada
| | - Marlee Held
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada
| | - Catherine St-Pierre
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada
| | - Cheng Yi Tsai
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada
| | - Richard Preuss
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada.,Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Montréal, Québec, Canada
| | | | - Monica Chan
- Shriners Hospital for Children-Canada, Montréal, Québec, Canada
| | - Paul A Martineau
- Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Louis-Nicolas Veilleux
- Faculty of Medicine, McGill University, Montréal, Québec, Canada.,Shriners Hospital for Children-Canada, Montréal, Québec, Canada
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19
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Kim DH, Kim SJ, Liu J, Beathe J, Memtsoudis SG. Fascial plane blocks: a narrative review of the literature. Reg Anesth Pain Med 2021; 46:600-617. [PMID: 34145072 DOI: 10.1136/rapm-2020-101909] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 12/16/2022]
Abstract
Fascial plane blocks (FPBs) are increasingly numerous and are often touted as effective solutions to many perioperative challenges facing anesthesiologists. As 'new' FPBs are being described, questions regarding their effectiveness remain unanswered as appropriate studies are lacking and publications are often limited to case discussions or technical reports. It is often unclear if newly named FPBs truly represent a novel intervention with new indications, or if these new publications describe mere ultrasound facilitated modifications of existing techniques. Here, we present broad concepts and potential mechanisms of FPB. In addition, we discuss major FPBs of (1) the extremities (2) the posterior torso and (3) the anterior torso. The characteristics, indications and a brief summary of the literature on these blocks is included. Finally, we provide an estimate of the overall level of evidence currently supporting individual approaches as FPBs continue to rapidly evolve.
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Affiliation(s)
- David H Kim
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
| | - Sang Jo Kim
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
| | - Jiabin Liu
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
| | - Jonathan Beathe
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
| | - Stavros G Memtsoudis
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA .,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
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20
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Criss CR, Melton MS, Ulloa SA, Simon JE, Clark BC, France CR, Grooms DR. Rupture, reconstruction, and rehabilitation: A multi-disciplinary review of mechanisms for central nervous system adaptations following anterior cruciate ligament injury. Knee 2021; 30:78-89. [PMID: 33873089 DOI: 10.1016/j.knee.2021.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 02/18/2021] [Accepted: 03/18/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Despite surgical reconstruction and extensive rehabilitation, persistent quadriceps inhibition, gait asymmetry, and functional impairment remain prevalent in patients after anterior cruciate ligament (ACL) injury. A combination of reports have suggested underlying central nervous system adaptations in those after injury govern long-term neuromuscular impairments. The classic assumption has been to attribute neurophysiologic deficits to components of injury, but other factors across the continuum of care (e.g. surgery, perioperative analgesia, and rehabilitative strategies) have been largely overlooked. OBJECTIVE This review provides a multidisciplinary perspective to 1) provide a narrative review of studies reporting neuroplasticity following ACL injury in order to inform clinicians of the current state of literature and 2) provide a mechanistic framework of neurophysiologic deficits with potential clinical implications across all phases of injury and recovery (injury, surgery, and rehabilitation) RESULTS: Studies using a variety of neurophysiologic modalities have demonstrated peripheral and central nervous system adaptations in those with prior ACL injury. Longitudinal investigations suggest neurophysiologic changes at spinal-reflexive and corticospinal pathways follow a unique timecourse across injury, surgery, and rehabilitation. CONCLUSION Clinicians should consider the unique injury, surgery, anesthesia, and rehabilitation on central nervous system adaptations. Therapeutic strategies across the continuum of care may be beneficial to mitigate maladaptive neuroplasticity in those after ACL injury.
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Affiliation(s)
- Cody R Criss
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA.
| | - M Stephen Melton
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - Sergio A Ulloa
- OhioHealth Physician Group Heritage College: Orthopedic and Sports Medicine, OhioHealth O'Bleness Memorial Hospital, Athens, OH, USA
| | - Janet E Simon
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA; Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
| | - Brian C Clark
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA; Department of Biomedical Sciences, Ohio University, Athens, OH, USA
| | - Christopher R France
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA; Department of Psychology, College of Arts and Sciences, Ohio University, Athens, OH, USA
| | - Dustin R Grooms
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA; Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA; Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
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21
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Nakase J, Shimozaki K, Asai K, Yoshimizu R, Kimura M, Tsuchiya H. Usefulness of lateral femoral cutaneous nerve block in combination with femoral nerve block for anterior cruciate ligament reconstruction: a prospective trial. Arch Orthop Trauma Surg 2021; 141:455-460. [PMID: 33386977 DOI: 10.1007/s00402-020-03724-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 12/06/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The study aimed to compare the combination of femoral nerve block (FNB) with interspace between the popliteal artery and the capsule of posterior knee (IPACK) block (IPACK group) with the combination of FNB with lateral femoral cutaneous nerve (LFCN) block (LFCN group) for postoperative pain control in patients undergoing anterior cruciate ligament (ACL) reconstruction. We hypothesized that the lower pain scores and decreased suppository use would be noted in patients administered a combination of FNB and IPACK block. MATERIALS AND METHODS A non-randomized prospective controlled clinical trial was conducted. The IPACK and LFCN groups included 40 patients each. The patients received IPACK block and LFCN block alternately. Thirty minutes prior to the surgery and after administration of general anesthesia, patients received an ultrasound-guided FNB and IPACK block or LFCN block. After ACL reconstruction, the visual analog scale pain scores were recorded at 30 min, 4 h, 8 h, 12 h, 24 h, 48 h, and 72 h after the surgery. The administration and use of analgesic suppositories were assessed. These measures were compared among the treatment types at each time-point using the Welch's t-test. RESULTS Suppository use was significantly less in the LFCN group than in the IPACK group. The pain scores were significantly lower in the LFCN group at 30 min, 4 h, 48 h, and 72 h after the surgery. CONCLUSION The combination of FNB with LFCN block during ACL reconstruction significantly reduces pain in the early postoperative period compared to a combination of FNB with IPACK block. LEVEL OF EVIDENCE Prospective control trial, Level II.
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Affiliation(s)
- Junsuke Nakase
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-0934, Japan.
| | - Kengo Shimozaki
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-0934, Japan
| | - Kazuki Asai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-0934, Japan
| | - Rikuto Yoshimizu
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-0934, Japan
| | - Mitsuhiro Kimura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-0934, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-0934, Japan
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