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Femoral nerve block and local instillation analgesia associated with more reliable efficacy in regional anesthesia interventions within 24 hours following anterior cruciate ligament reconstruction: a network meta-analysis.

Published:January 25, 2023DOI:https://doi.org/10.1016/j.arthro.2022.12.014

      Abstract

      Purpose

      To systematically review the current evidence in the literature to compare the efficacy of different regional anesthesia interventions in the treatment of 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 two 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% CrI, -1.28 to -0.12). Compared with placebo, significant reduction in opioid consumption was found in LIA (MD, -13.29 mg; 95% CrI, -21.77 to -4.91) and FNB (MD, -13.97 mg; 95% CrI, -24.71 to -3.04). Femoral and sciatic nerve block (FSNB) showed the highest ranking for pain relief and opioid consumption without significant evidence (p>0.05) to support superiority in comparison to placebo, respectively.

      Conclusion

      Our meta-analysis shows that FNB and LIA can significantly diminish postoperative pain and reduce opioid consumption following ACLR compared to placebo in the setting of regional anesthesia, and FSNB may be the top 1 ranked analgesic technique despite of high uncertainty.
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