Purpose
To assess the relative effectiveness of different regional anesthetic techniques (peripheral
nerve blocks, local instillation analgesia, including intra-articular, subcutaneous,
and periarticular infiltration) in patients undergoing anterior cruciate ligament
reconstruction (ACLR).
Methods
PubMed, Embase, Cochrane Library, and Web of Science databases were searched from
their inception to December 31, 2020. The search was supplemented by manual review
of relevant reference lists. Randomized controlled trials of participants after ACLR
that compared regional anesthesia interventions were selected. The 2 coprimary outcomes
were (1) rest pain scores and (2) cumulative oral morphine equivalent consumption
on day 1 (24 hours) post-ACLR. Data were pooled using a Bayesian framework.
Results
Of 759 records identified, 46 trials were eligible, evaluating 9 interventions in
3,171 patients. Local instillation analgesia (LIA), including intra-articular, subcutaneous,
and periarticular infiltration, had significant improvement in pain relief as compared
with placebo (–0.91; 95% CrI –1.45 to –0.37). Femoral nerve block (FNB) also showed
significant effects in relieving pain as compared with placebo (–0.70; 95% 95% credible
interval [CrI] –1.28 to –0.12). Compared with placebo, a significant reduction in
opioid consumption was found in LIA (mean difference –13.29 mg; 95% CrI –21.77 to
–4.91) and FNB (mean difference –13.97 mg; 95% CrI –24.71 to –3.04). Femoral and sciatic
nerve block showed the greatest ranking for pain relief and opioid consumption without
significant evidence (P > .05) to support superiority in comparison with placebo, respectively.
Conclusions
Our meta-analysis shows that FNB and LIA can significantly diminish postoperative
pain and reduce opioid consumption following ACLR compared with placebo in the setting
of regional anesthesia, and femoral and sciatic nerve block may be the number 1 top-ranked
analgesic technique despite high uncertainty.
Level of Evidence
I, Systematic review of Level I studies.
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Article info
Publication history
Published online: January 25, 2023
Accepted:
December 1,
2022
Received:
January 23,
2022
Footnotes
See commentary on page 1296
The authors report the following potential conflicts of interest or sources of funding: This study was funded by Beijing municipal science and technology commission (grant number Z191100006619023, Z201100005520058) and the Capital Health Research and Development of Special (grant number 2020-2-4061). The Fund's role is to provide review and publishing costs. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2022 Published by Elsevier on behalf of the Arthroscopy Association of North America
