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  • i

    POSTOPERATIVE ANALGESIA USING PSOAS SHEATH BLOCK VERSUS THREE-IN-ONE BLOCK IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

    Captain Cheryl A. Burch

    APPROVED:

    ___________________________________________________________ Maura S. McAuliffe, CRNA, Ph.D., Chair Date

    ___________________________________________________________ Eugene Levine, Ph.D., Member Date

    ___________________________________________________________ Jaime Dickerson, MD, Major, USAF, MC Date

    ___________________________________________________________ Melydia Edge, CRNA, Lt. Col., USAF, NC Date

    APPROVED:

    ___________________________________________________________ F.D. Abdellah, Ed.D., ScD., RN, FAAN Date

  • Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for the collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to a penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.

    1. REPORT DATE OCT 1999

    2. REPORT TYPE N/A

    3. DATES COVERED -

    4. TITLE AND SUBTITLE POSTOPERATIVE ANALGESIA USING PSOAS SHEATH BLOCK VS THREE-IN-ONE BLOCK IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

    5a. CONTRACT NUMBER

    5b. GRANT NUMBER

    5c. PROGRAM ELEMENT NUMBER

    6. AUTHOR(S) CAPTAIN Cheryl A. Burch, R.N., B.S.N

    5d. PROJECT NUMBER

    5e. TASK NUMBER

    5f. WORK UNIT NUMBER

    7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Uniformed Services University of the Health Sciences

    8. PERFORMING ORGANIZATION REPORT NUMBER

    9. SPONSORING/MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR/MONITOR’S ACRONYM(S)

    11. SPONSOR/MONITOR’S REPORT NUMBER(S)

    12. DISTRIBUTION/AVAILABILITY STATEMENT Approved for public release, distribution unlimited

    13. SUPPLEMENTARY NOTES

    14. ABSTRACT In this study, the effects of two regional anesthetic techniques on postoperative pain of patients undergoing anterior cruciate ligament reconstruction surgery were described. Patients were assigned the morning of surgery to one of two groups. Subjects in Group A received a psoas sheath and sciatic nerve blocks and subjects in Group B received a three-in-one and sciatic nerve block. Additionally, all subjects received either a propofol infusion for sedation or a general inhalational anesthetic. Sixteen subjects were enrolled, 12 in Group A and four in Group B. Mean time from the end of surgery to the patients first request for pain medication was 7.7 hours (SD 1.9) for Group A and 11 hours (SD 1.1) for Group B. Mean time to administer the regional nerve blockade for was 15.3 minutes (SD 7.5; range 7-30) and 23.5 minutes (SD 9.9; range 15-25) for Group A and B respectively. The regional techniques for Group A (n=12, 2=no data) resulted in blockade of all nerves for 8 of the 10 (80%) subjects. The regional techniques for Group B (n=4) yielded two cases which no nerves were blocked and two cases where all nerves were blocked.

    15. SUBJECT TERMS Regional Anesthesia; Lumbar Plexus Block, Postoperative Pain Management; Pre-emptive analgesia

    16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT

    SAR

    18. NUMBER OF PAGES

    73

    19a. NAME OF RESPONSIBLE PERSON

    a. REPORT unclassified

    b. ABSTRACT unclassified

    c. THIS PAGE unclassified

    Standard Form 298 (Rev. 8-98) Prescribed by ANSI Std Z39-18

  • iii

    DISCLAIMER STATEMENT

    This work was supported by the Uniformed Services

    University of the Health Sciences Protocol Number T06191.

    The opinions or assertions contained herein are the private

    opinions of the author and are not to be construed as

    official or reflecting the views of the Department of

    Defense or the Uniformed Services University of the Health

    Sciences.

  • iv

    COPYRIGHT STATEMENT

    The author hereby certifies that the use of any copyrighted

    material in the thesis entitled:

    "POSTOPERATIVE ANALGESIA USING PSOAS SHEATH BLOCK OR THREE

    IN-ONE BLOCK IN ANTERIOR CRUCIATE LIGAMENT REPAIR SURGERY"

    beyond brief excerpts is with the permission of the

    copyright owner, and will save and hold harmless the

    Uniformed Services University of the Health Sciences from

    any damage which may arise from such copyright violations.

  • v

    ABSTRACT

    In this study, the effects of two regional anesthetic

    techniques on postoperative pain of patients undergoing

    anterior cruciate ligament reconstruction surgery were

    described. Patients were assigned the morning of surgery to

    one of two groups. Subjects in Group A received a psoas

    sheath and sciatic nerve blocks and subjects in Group B

    received a three-in-one and sciatic nerve block.

    Additionally, all subjects received either a propofol

    infusion for sedation or a general inhalational anesthetic.

    Sixteen subjects were enrolled, 12 in Group A and four in

    Group B. Mean time from the end of surgery to the

    patient’s first request for pain medication was 7.7 hours

    (SD 1.9) for Group A and 11 hours (SD 1.1) for Group B.

    Mean time to administer the regional nerve blockade for was

    15.3 minutes (SD 7.5; range 7-30) and 23.5 minutes (SD 9.9;

    range 15-25) for Group A and B respectively. The regional

    techniques for Group A (n=12, 2=no data) resulted in

    blockade of all nerves for 8 of the 10 (80%) subjects. The

    regional techniques for Group B (n=4) yielded two cases

    which no nerves were blocked and two cases where all nerves

    were blocked.

    Key Words: Regional Anesthesia; Lumbar Plexus Block,

    Postoperative Pain Management; Pre-emptive analgesia

  • vi

    POSTOPERATIVE ANALGESIA USING PSOAS SHEATH BLOCK VS THREE- IN-ONE BLOCK IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

    by

    CAPTAIN Cheryl A. Burch, R.N., B.S.N

    THESIS

    Presented to the Graduate School of Nursing Faculty of

    the Uniformed Services University of the Health

    Sciences in Partial Fulfillment of the

    Requirements for the

    Degree of

    MASTER OF SCIENCE

    UNIFORMED SERVICES UNIVERSITY OF THE HEALTH SCIENCES October 1999

  • vii

    PREFACE

    This research was conducted to provide information on two

    different regional anesthetic techniques and their effect

    on postoperative pain of patients undergoing anterior

    cruciate ligament repair surgery.

  • viii

    DEDICATION

    To my mother, I dedicate this paper. Thank you for

    instilling in me the desire for knowledge and for always

    telling me I could do anything I put my mind to.

  • ix

    TABLE OF CONTENTS

    PREFACE.................................................vii

    DEDICATION.............................................viii

    LIST OF TABLES...........................................xi

    CHAPTER I: INTRODUCTION...................................1

    Background................................................1

    Purpose...................................................3

    Research Questions........................................3

    Conceptual Framework......................................4

    Neural Circuitry Theory...................................4

    Abdellah’s Theory.........................................7

    Definitions Conceptual and Operational...................11

    Measurement..............................................13

    Assumptions and Limitations..............................13

    CHAPTER II: REVIEW OF LITERATURE.........................15

    Introduction.............................................15

    Clinical Studies.........................................19

    Regional Techniques......................................21

    Conclusion...............................................25

    Summary..................................................26

    CHAPTER III: METHODOLOGY.................................27

    Introduction.............................................27

    Design, Sample and Procedures............................27

  • x

    Local Anesthetic.........................................29

    Sciatic Nerve Blockade...................................29

    Three-In-One Nerve Blockade..............................31

    Psoas Sheath Nerve Blockade..............................32

    Protection of Human Rights...............................34

    Data Analysis............................................34

    Summary................................

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