A Novel Technique for Administering Hamstring Donor-Site Analgesia during Anterior Cruciate Ligament Reconstruction

Introduction

Postoperative pain following anterior cruciate ligament reconstruction can be mitigated by delivery of local anaesthetic along the hamstring harvest bed [1]. Initially described using an arthroscopic shaver sleeve to deliver the anaesthetic [2], subsequent techniques have described using suction catheter tubing [3]. However, the flexibility of suction tubing can cause problems advancing it along the harvest bed. We describe a novel technique for administering local anaesthetic to the hamstring donor-site.

Technique

A sterile packed anaesthetic bougie (Cook Medical LLC, Bloomington, USA) (Figure 1) is opened and kept sterile. The proximal end is cut toaccomodate a 20 ml Luer slip-type syringe containing 0.25% Chirocaine (Figure 2, Figure 3 and Figure 4). The rigidity of the bougie aids passage along the tract of the hamstring donor-site and the local anaesthetic is injected as the bougie is withdrawn.

Expected Outcome

Patients have improved post-operative pain as expected from local anaesthetic delivery along the hamstring harvest site [1]. The rigidity of the anaesthetic bougie reduces difficulty passing it against the soft tissue envelope and minimises operative time to complete this important step. The malleability of the bougie enables it to be pre-bent to ease passage along the hamstring harvest site.

Complications

No complications have been experienced using this technique.

Conflicts of Interest

The authors declare no conflict of interests.

References

1. Faunø P, Lund B, Christiansen SE, et al. (2015) Analgesic effect of hamstring block after anterior cruciate ligament reconstruction compared with placebo: A prospective randomized trial. Arthroscopy 31: 63-68.
2. Bushnell BD, Sakryd G, Noonan TJ (2010) Hamstring donor-site block: Evaluation of pain control after anterior cruciate ligament reconstruction. Arthroscopy 26: 894-900.
3. Logan JS, Elliot RR, Wilson AJ (2011) A new technique for hamstring donor site blockade in anterior cruciate ligament reconstruction. Annals of the Royal College of Surgeons 93: 326.