Description
Objectives: Anterior cruciate ligament (ACL) reconstruction is commonly associated with moderate-to-severe postoperative pain. Early postoperative pain management following anterior cruciate ligament (ACL) reconstruction commonly involves the use of periarticular multi-drug cocktail injection (PI), a femoral nerve block (FNB) with a lateral femoral cutaneous nerve block (LFCNB) or adductor canal block (ACB) with LFCNB. Various studies have reported on the analgesic effects of these treatments. However, there are no study comparing the effects of PI, FNB with LFCNB and ACB with LFCNB for pain control after ACL reconstruction. This study aimed to assess the effects of PI, FNB with LFCNB and ACB with LFCNB for pain relief in the early postoperative period after ACL reconstruction.
Methods: This study was conducted as a retrospective controlled clinical trial, enrolling a total of 299 patients who had undergone primary ACL reconstruction at our hospital between April 2016 and October 2022. We categorized 299 cases into groups based on the use of PI (PI group), FNB with LFCNB (FNB group), and ACB with LFCNB (ACB group) for pain management, and selected 40 cases each with matched age, sex, and BMI from each group, resulting in a total of 120 cases for analysis. In the FNB and ACB groups, 0.75% ropivacaine 20ml was injected under ultrasound guidance just before surgery. In the PI group, a mixture of 0.75% ropivacaine 20ml, normal saline 20ml, and dexamethasone 6.6mg was injected half at the start of surgery and the rest just before wound closure. Patient demographics (age, sex, height, body weight, and BMI) and surgical data (the requirement for meniscal repair, operative time, and tourniquet inflation time) were analyzed. After ACL reconstruction, patients' numerical rating scale pain scores (NRS) (ranging from 0 to 10) were recorded at 30 minutes, as well as at 4, 8, 12, 24, 48, and 72 hours post-surgery. NRS were then compared among the three groups using analysis of variance. In addition, within each group, these data were compared between the NRS ≥ 7 and NRS ≤ 6 groups using t-test.
Results: There were no significant differences in patient demographics and surgical data. Pain scores were significantly higher in the PI group than in the FCB and ACB groups 30 minutes after surgery (p < 0.01), but they were lower at 12, 24, 48, and 72 hours post-surgery (p < 0.01). In the FNB group, there were no significant differences in the demographic and surgical data by numerical rating scale pain score. In the ACB group, the number of men was significantly higher in the NRS ≥ 7 group than in the NRS ≤ 6 group (p = 0.015). In the PI group, tourniquet inflation time was significantly longer in the NRS ≥ 7 group than in the NRS ≤ 6 group (p = 0.008).
Conclusions: In the early postoperative period after ACL reconstruction, PI showed less effective immediate postoperative pain relief compared to nerve blocks, but it displayed superior analgesic effects after the initial 12-hour period.
