Summary

LIA technique provided equally good pain relief following ACL reconstruction when compared to ACB, while allowing for earlier rehabilitation, mobilisation and discharge.

Abstract

Objectives: To determine the effectiveness of LIA compared to adductor nerve blocks in providing pain relief and opiate usage in ACL reconstructions.

Materials And Methods

In a consecutive series of ACL reconstructions, patients received three different postoperative regional and/or anaesthetic techniques for pain relief. Three groups were studied: group 1: general anaesthetic (GA)+ adductor canal block (ACB) (n=38); group 2: GA + ACB + local infiltration anaesthesia (LIA) (n=31) and group 3: GA+LIA (n=36). Adductor block was given under ultrasound guidance. LIA involved infiltration at skin incision site, capsule, periosteum and in hamstring harvest tunnel. Rest of analgesic medications were similar between the three groups as per standard multimodal analgesia (MMA). Patients were similar in demographics distribution and surgical technique/procedure. The postoperative pain and total morphine requirement were evaluated and recorded. The postoperative pain was assessed VAS at 0hrs, 2hrs, 4hrs, weight bearing (WB) and discharge (DC).

Results

There was no statistically significant difference in opiates intake amongst the three groups. When comparing VAS scores; there were no statistical difference between the groups at any of the time intervals that VAS was measured. Group 1 VAS scores at 0hrs were mean(m) and 95%confidence intervals (CI) m=30.47±9.95mm; at 2hrs m=30.64±7.37mm; at 4hrs m=33.57±5.8mm; at WB m=35.68±5.47mm; and at DC m=36.89±5.67mm. Group 2 VAS scores were at 0hrs m=32.09±3.54mm; at 2hrs m=30.34±2.6mm; at 4hrs m=30.96±1.84mm; at WB m=30.64±1.42mm; and at DC m=30.96±2.42mm. Group 3 VAS scores were at 0hrs m=30.5±8.76mm; at 2 hrs m= 34.38±6.82mm; at 4hrs m=36.16±6.5mm; at WB m=34.05±4.85mm; and at DC m=35.44±4.73mm. However, the GA+LIA group hospital’s LOS (MD=2.31hrs, SD=0.75) was almost half that of GA+ACB group (4.24hrs, SD=1.08); (conditions t(72)=8.88; p=0.000). There was no statistical significance in the incidence of adverse effects amongst the groups.

Conclusion

LIA technique provided equally good pain relief following ACL reconstruction when compared to ACB, while allowing for earlier rehabilitation, mobilisation and discharge.