Anterior cruciate ligament reconstruction utilizing a hamstring autograft is a surgical technique that has gained popularity among orthopedic surgeons caring for adolescent patients. While utilization of a hamstring autograft is a revered technique, harvest of the hamstring yields significant pain. Sciatic peripheral nerve blockade has proven to reliably provide analgesia at the hamstring donor site. Single-injection sciatic peripheral nerve blockade is considered a basic and effective technique, making its use following anterior cruciate ligament reconstruction standard practice in many institutions. The duration of action of a single-injection sciatic peripheral nerve blockade may fail to outlast the pain arising from the hamstring donor site, prompting some clinicians to employ continuous sciatic peripheral nerve blockade via an indwelling catheter. A lack of comparative effectiveness studies exists in the literature regarding the duration of action of peripheral nerve blockade necessary to adequately provide pain control following hamstring autograft harvest, resulting in disagreement among clinicians as to best pain control practices. Proponents of continuous sciatic peripheral nerve blockade assert that while more costly, the extended duration of analgesia afforded by this technique improves pain control postoperatively and decreases the use of other pain medications. Advocates of single-injection sciatic peripheral nerve blockade cite concerns associated with continuous sciatic peripheral nerve blockade known to be detrimental to rehabilitation, such as decreased active knee flexion and increased risk of falls. The purpose of this research is to compare the effect of single-injection sciatic PNB to continuous sciatic PNB on 1) postoperative pain control as measured by self-reported pain scores, pain medication use, and unplanned hospital admission due to poor pain control, 2) active knee flexion, and 3) patient satisfaction with pain control following ACL reconstruction with a hamstring autograft. The findings of this study have the potential to guide informed clinical reasoning and decision making regarding sciatic peripheral nerve blockade techniques following hamstring autograft harvest in adolescents undergoing anterior cruciate ligament reconstruction.

Hip arthroscopy is a minimally invasive alternative to open hip surgery. Despite its minimally invasive nature, there can still be significant reported pain following these procedures. The impact of combined sciatic and lumbar plexus nerve blocks on postoperative pain scores and opioid consumption in patients undergoing hip arthroscopy was investigated. A retrospective analysis of 176 patients revealed that compared with patients with no preoperative peripheral nerve block, significant reductions in pain scores to 24 hours were reported and decreased opioid consumption during the post anesthesia care unit (PACU) stay was recorded; no significant differences in opioid consumption out to 24 hours were discovered. A subgroup analysis comparing two approaches to the sciatic nerve block in patients receiving the additional lumbar plexus nerve block failed to reveal a significant difference for this patient population. We conclude that peripheral nerve blockade can be a useful analgesic modality for patients undergoing hip arthroscopy.