Summary
Adding adductor canal block (ACB) to local infiltration analgesia (LIA) in ACL reconstruction did not significantly reduce postoperative opioid use, except in patients with hamstring grafts, though it was associated with longer discharge times
Abstract
Purpose
Optimizing pain management after ACL reconstruction is crucial for early rehabilitation and minimizing opioid use. The benefits of adductor canal block (ACB) over local infiltration analgesia (LIA) alone are debated. Despite common practice combining ACB and LIA, the efficacy of adding ACB to LIA in reducing postoperative opioid use is not well established. This propensity-matched cohort study aimed to determine if adding ACB to LIA reduces immediate postoperative opioid use in ACL reconstruction and assess variations based on graft type. We hypothesized that ACB addition to LIA will reduce opioid use.
Methods
We matched patients undergoing ACL reconstruction who received LIA only to those who received LIA and ACB perioperatively. Perioperative morphine consumption was analyzed in 300 patients who underwent ACL reconstruction between 2019 and 2021. Subgroup analysis was performed based on autograft type (hamstring, quadriceps tendon, and patellar bone-tendon-bone).
Results
No significant differences were found between the ACB + LIA (27.76 ± 14.01 mg) and LIA only (28.58 ± 12.56 mg) groups in terms of intraoperative, PACU, or total perioperative opioid consumption. This lack of difference held true across all autograft types. However, in the hamstring group, a significant reduction in PACU opioid consumption was observed when ACB was added to LIA (p = 0.0390). Additionally, patients in the ACB + LIA group had a significantly longer mean time to discharge (495 ± 113 minutes) compared to the LIA only group (463 ± 116 minutes; p = 0.017).
Conclusion
Our findings suggest that adding ACB to LIA does not provide additional opioid-sparing benefits in ACL reconstruction, except in patients with hamstring grafts. The increased discharge time with ACB warrants further investigation to balance benefits with operational efficiency.
Keywords: ACL reconstruction, local infiltration anesthesia, adductor canal block, opioid use
Level of Evidence: Level II