Comparing Subsartorial Saphenous Nerve Blocks With and Without Dexamethasone for Anterior Cruciate Ligament Reconstruction

Phase 4

Completed

Conditions: Anterior Cruciate Ligament Reconstruction
Regional Anesthesia, Saphenous Nerve Block

Interventions: Drug: Bupivacaine Only
Drug: Bupivacaine with 1 mg of Dexamethasone
Drug: Bupivacaine with 4 mg of Dexamethasone

Brief Summary: For patients undergoing Anterior Cruciate Ligament reconstruction surgery, the postoperative period can be a painful experience without adequate pain management. Hence the investigators propose a randomized controlled clinical study, investigating prolonged saphenous nerve blocks. Patients will be randomized to receive saphenous nerve blocks with or without dexamethasone, a corticosteroid used to prolong analgesia.

Depending on the randomized treatment assignment, patients may receive one of the following:

1. 13 ml of 0.5% bupivacaine, a local anesthetic (no dexamethasone);

2. 13 ml of 0.5% bupivacaine mixed with 1 mg of dexamethasone;

3. 13 ml of 0.5% bupivacaine mixed with 4 mg of dexamethasone.

Patients will be followed postoperatively. Following admission to the recovery room, data collectors will ask patients to rate their pain on a scale of 0-10 until discharge. Data collectors will also record patient satisfaction, pain medication use and any side effects experienced (i.e. nausea and vomiting). Patients will then be contacted on postoperative days 1, 2 and 14 and asked questions about their general well-being.

Recruitment & Eligibility

Inclusion Criteria

Patients undergoing ambulatory surgery for anterior cruciate ligament (ACL) reconstruction with a patella tendon autograft.
ASA I-III [American Society of Anesthesiologists (ASA) Physical Status classification system]
BMI < 35
Smokers included
Ages 16-65

Exclusion Criteria

Patients on steroids or requiring stress dose steroids
BMI > 35
Patient refusal
Allergy to study medications,
NRS scores > 3 with frequent opioid use (including tramadol) prior to surgery-daily for greater than 3 weeks
Lower extremity neurological dysfunction
Diabetic (NIDDM, insulin-dependent and/or oral hypoglycemic dependent)
Not in included age range (under 16 or over 65 years of age)
Contraindications to the use of dexamethasone
Non-English speaking patients. We will be using the Short Form 8 Health Survey, as well as the OR-SDS questionnaire (these are in English; any translations would have to be separately validated).

Arm && Interventions

Group	Intervention	Description
Control	Bupivacaine Only	-
Dexamethasone 1 mg	Bupivacaine with 1 mg of Dexamethasone	-
Dexamethasone 4 mg	Bupivacaine with 4 mg of Dexamethasone	-

Primary Outcome Measures

Name	Time	Method
Patient-perceived Duration of Analgesia	Up to 2 days following surgery	After discharge, patients will be called and given instructions to help determine length of time of analgesia in the saphenous nerve distribution.

Secondary Outcome Measures

Name	Time	Method
NRS (Numerical Rating Scale) Pain Scores	Postoperative day 1	Patients will be asked to rate, on a scale of 0-10, their pain while at rest. 0 indicates no pain, and 10 indicates the worst pain imaginable.
Patient Satisfaction	Up to 2 days following surgery	Patients will be asked to rate satisfaction on a scale of 0-10 (0=completely dissatisfied, 10=completely satisfied);
Postoperative Morphine Consumption	Up to 2 days following surgery	Data collector will record how many opioids (i.e. Percocet, Vicodin) the patient has used since discharge.
Opioid-Related Side Effects (Drowsiness)	Up to 2 days following surgery	Data collector will administer the Opioid-Related Distress Scale (OR-SDS) to determine if patients experience any opioid-related side effects (i.e. drowsiness). The OR-SDS score is on a scale of 0 to 4, with a higher number representing more severe symptoms.