Ultrasound guided proximal adductor canal and pes anserinus blocks improve early recovery after arthroscopic ACL reconstruction

To explore the impact of ultrasound-guided proximal adductor canal and pes anserinus tendon block on early recovery after anterior cruciate ligament reconstruction surgery via daytime knee arthroscopy. A total of 127 patients, aged 18-60 years, with ASA class I-II, undergoing anterior cruciate ligament reconstruction via knee arthroscopy under general anesthesia with laryngeal mask airway intubation, were selected. These patients were randomly divided into three groups: Group C (43 cases), Group N₁ (41 cases), and Group N₂ (43 cases). Control group C: received proximal block of the adductor canal with 0.5% ropivacaine (15 ml); Experimental group N₁: received proximal block of the adductor canal combined with tendon block of the pes anserinus with 0.5% ropivacaine (15 ml per site); Experimental group N₂: received proximal block of the adductor canal combined with tendon block of the pes anserinus with 0.5% ropivacaine plus 5 mg dexamethasone (15 ml per site). Record the VAS scores at each time point after awakening, 3 h after surgery, 6 h after surgery, 12 h after surgery, 24 h after surgery, 48 h after surgery, and 72 h after surgery during rest and knee flexion activities of the knee joint. Record the quadriceps muscle strength after awakening, Ramsay sedation score after awakening, time of first ambulation after surgery, and the amount of sufentanil, propofol, and remifentanil used during the operation. Record the amount of tramadol and flurbiprofen axetil added postoperatively. Record the anxiety scores and rapid eye movement sleep behavior disorder scores before and 3 days after surgery. Record the occurrence of breakthrough pain and adverse reactions 3 days after surgery. Compared with Group C, both Group N₁ and Group N₂ showed significantly lower rest and activity VAS scores at all time points on postoperative day 3 (P < 0.05), earlier time to first ambulation after surgery (P < 0.05), significantly lower HADS-A scores and sleep scores on postoperative day 3 (P < 0.05), significantly higher Ramsay sedation scores after awakening (P < 0.05), and significantly reduced use of additional tramadol and flurbiprofen axetil after surgery (P < 0.05). The intraoperative sufentanil dosage was also significantly reduced (P < 0.05). There were no statistically significant differences in quadriceps muscle strength and adverse reactions during the awakening period among the three groups (P > 0.05). Ultrasound-guided proximal adductor canal and pes anserinus tendon block (15 ml of 0.5% ropivacaine each) can effectively alleviate pain 3 days after anterior cruciate ligament reconstruction surgery under knee arthroscopy, with good analgesic effects, and has minimal impact on quadriceps muscle strength after awakening, promoting early postoperative ambulation; at the same time, this blocking method can reduce the occurrence of postoperative anxiety and sleep disorders.