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Periarticular Local Infiltrative Anesthesia and Regional Adductor Canal Block Provide Equivalent Pain Relief After Anterior Cruciate Ligament Reconstruction

Published:November 18, 2021DOI:https://doi.org/10.1016/j.arthro.2021.10.031

      Purpose

      To compare postoperative pain and recovery after anterior cruciate ligament reconstruction (ACLR) in patients who received an adductor canal block (ACB) or periarticular local infiltrative anesthesia (LIA).

      Methods

      A retrospective review of a prospectively collected ACL registry was performed. Patients underwent ACLR at a single institution between January 2015 and September 2020 and received long-acting local anesthesia with a preoperative ultrasound-guided ACB or periarticular LIA after surgery. Visual analog scale (VAS) pain scores, milligram morphine equivalents (MME) consumed in the post-anesthesia care unit (PACU), and total hospital recovery time were compared. Univariate analysis was used to compare VAS pain and MME totals between overall groups and groups propensity score matched for age, sex, body mass index, graft type, and meniscal treatment. Results are presented as mean (95%CI) unless otherwise indicated.

      Results

      There were 265 knees (253 patients) included (LIA, 157 knees; ACB, 108 knees). Overall, VAS pain scores before hospital discharge (LIA: 2.6 [2.4-2.8] vs ACB: 2.4 [2.1-2.7]; P = .334) and total MMEs were similar (LIA: 17.6 [16.4-18.8] vs ACB: 18.5 [17.2-19.8] (MME); P =.134). Median time to discharge also did not significantly differ (LIA: 137.5 [IQR: 116-178] vs. ACB: 147 [IQR: 123-183] (min); P = .118). Matched subanalysis (LIA and ACB; n = 94) did not reveal significant differences in VAS pain before discharge (LIA: 2.4 [2.1-2.7] vs ACB: 2.7 [2.4-3.0]; P = .134) or total MMEs (LIA: 18.6 (17.2-20.0) vs ACB: 17.9 (16.4-19.4); P = .520).

      Conclusion

      The use of ACB or LIA resulted in similar early pain levels, opioid consumption, and hospital recovery times after ACLR surgery. Level of Evidence: III, retrospective comparison study.

      Key Words

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      References

        • Secrist E.S.
        • Freedman K.B.
        • Ciccotti M.G.
        • Mazur D.W.
        • Hammoud S.
        Pain management after outpatient anterior cruciate ligament reconstruction: A systematic review of randomized controlled trials.
        Am J Sports Med. 2016; 44: 2435-2447
        • Jansson H.
        • Narvy S.J.
        • Mehran N.
        Perioperative pain management strategies for anterior cruciate ligament reconstruction.
        JBJS Rev. 2018; 6: e3
        • Abdallah F.W.
        • Brull R.
        • Joshi G.P.
        Pain management for ambulatory arthroscopic anterior cruciate ligament reconstruction: Evidence-based recommendations from the Society for Ambulatory Anesthesia.
        Anesth Analg. 2019; 128: 631-640
        • Williams B.A.
        • Kentor M.L.
        • Vogt M.T.
        • et al.
        Economics of nerve block pain management after anterior cruciate ligament reconstruction: Potential hospital cost savings via associated postanesthesia care unit bypass and same-day discharge.
        Anesthesiology. 2004; 100: 697-706
        • Everhart J.S.
        • Hughes L.
        • Abouljoud M.M.
        • Swank K.
        • Lewis C.
        • Flanigan D.C.
        Femoral nerve block at time of ACL reconstruction causes lasting quadriceps strength deficits and may increase short-term risk of re-injury.
        Knee Surg Sports Traumatol Arthrosc. 2020; 28: 1894-1900
        • Abdallah F.W.
        • Whelan D.B.
        • Chan V.W.
        • et al.
        Adductor canal block provides noninferior analgesia and superior quadriceps strength compared with femoral nerve block in anterior cruciate ligament reconstruction.
        Anesthesiology. 2016; 124: 1053-1064
        • Memtsoudis S.G.
        • Danninger T.
        • Rasul R.
        • et al.
        Inpatient falls after total knee arthroplasty: The role of anesthesia type and peripheral nerve blocks.
        Anesthesiology. 2014; 120: 551-563
        • Burckett-St Laurant D.
        • Peng P.
        • Girón Arango L.
        • et al.
        The nerves of the adductor canal and the innervation of the knee: An anatomic study.
        Reg Anesth Pain Med. 2016; 41: 321-327
        • Chen J.
        • Lesser J.B.
        • Hadzic A.
        • Reiss W.
        • Resta-Flarer F.
        Adductor canal block can result in motor block of the quadriceps muscle.
        Reg Anesth Pain Med. 2014; 39: 170-171
        • Yung E.M.
        • Brull R.
        • Albrecht E.
        • Joshi G.P.
        • Abdallah F.W.
        Evidence basis for regional anesthesia in ambulatory anterior cruciate ligament reconstruction: Part III: Local instillation analgesia—A systematic review and meta-analysis.
        Anesth Analg. 2019; 128: 426-437
        • Albrecht E.
        • Guyen O.
        • Jacot-Guillarmod A.
        • Kirkham K.R.
        The analgesic efficacy of local infiltration analgesia vs femoral nerve block after total knee arthroplasty: A systematic review and meta-analysis.
        Br J Anaesth. 2016; 116: 597-609
        • Kirkham K.R.
        • Grape S.
        • Martin R.
        • Albrecht E.
        Analgesic efficacy of local infiltration analgesia vs. femoral nerve block after anterior cruciate ligament reconstruction: A systematic review and meta-analysis.
        Anaesthesia. 2017; 72: 1542-1553
        • Stebler K.
        • Martin R.
        • Kirkham K.R.
        • Lambert J.
        • De Sede A.
        • Albrecht E.
        Adductor canal block versus local infiltration analgesia for postoperative pain after anterior cruciate ligament reconstruction: A single centre randomised controlled triple-blinded trial.
        Br J Anaesth. 2019; 123: e343-e349
        • Roos E.M.
        • Lohmander L.S.
        The knee injury and osteoarthritis outcome score (KOOS): From joint injury to osteoarthritis.
        Health Qual Life Outcomes. 2003; 1: 64
        • Centers for Disease Control and Prevention
        CDC guideline for prescribing opioids for chronic pain.
        U.S. Department of Health and Human Services, Washington, D.C.2019
        • Harris J.D.
        • Brand J.C.
        • Cote M.P.
        • Faucett S.C.
        • Dhawan A.
        Research Pearls: The significance of statistics and perils of pooling. Part 1: Clinical versus statistical significance.
        Arthroscopy. 2017; 33: 1102-1112
        • Dunn W.R.
        • Spindler K.P.
        • Amendola A.
        • et al.
        Which preoperative factors, including bone bruise, are associated with knee pain/symptoms at index anterior cruciate ligament reconstruction (ACLR)? A Multicenter Orthopaedic Outcomes Network (MOON) ACLR Cohort Study.
        Am J Sports Med. 2010; 38: 1778-1787
        • U.S. Department of Health and Human Services
        Calculate Your Body Mass Index.
        NIH, National Heart, Lung, and Blood Institute, Bethesda, MD2021
        • Jaeger P.
        • Nielsen Z.J.
        • Henningsen M.H.
        • Hilsted K.L.
        • Mathiesen O.
        • Dahl J.B.
        Adductor canal block versus femoral nerve block and quadriceps strength: A randomized, double-blind, placebo-controlled, crossover study in healthy volunteers.
        Anesthesiology. 2013; 118: 409-415
        • Yee E.J.
        • Gapinski Z.A.
        • Ziemba-Davis M.
        • Nielson M.
        • Meneghini R.M.
        Quadriceps weakness after single-shot adductor canal block: A multivariate analysis of 1,083 primary ttal knee arthroplasties.
        J Bone Joint Surg Am. 2021; 103: 30-36
        • Palmieri-Smith R.M.
        • Lepley L.K.
        Quadriceps strength asymmetry after anterior cruciate ligament reconstruction alters knee joint biomechanics and functional performance at time of return to activity.
        Am J Sports Med. 2015; 43: 1662-1669
        • Espelund M.
        • Fomsgaard J.S.
        • Haraszuk J.
        • Mathiesen O.
        • Dahl J.B.
        Analgesic efficacy of ultrasound-guided adductor canal blockade after arthroscopic anterior cruciate ligament reconstruction: A randomised controlled trial.
        Eur J Anaesthesiol. 2013; 30: 422-428