2015 ISAKOS Biennial Congress ePoster #1243

Periarticular Injection Versus Femoral Nerve Block for Pain Control After ACL Reconstruction

Kenji Kurosaka, MD, Nishinomiya, Hyogo JAPAN
Hiroshi Nakayama, MD, Nishinomiya, Hyogo JAPAN
Kaori Kashiwa, MD, PhD, Sasayama, Hyogo JAPAN
Takatoshi Morooka, MD, Nishinomiya, Hyogo JAPAN
Tomoya Iseki, MD, PhD, Nishinomiya, Hyogo JAPAN
Ryo Kanto, MD, Nishinomiya, Hyogo JAPAN
Shota Morimoto, MD, Nishinomiya, Hyogo JAPAN
Shinichi Yoshiya, MD, Nishinomiya, Hyogo, Hyogo JAPAN
Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, JAPAN

FDA Status Cleared

Summary: Periarticular multimodal drug injection was safe and significantly more effective than femoral nerve block as a pain control measure following double-bundle hamstring ACL reconstruction.

Abstract:

Introduction

Optimization of the surgical technique for anterior cruciate ligament (ACL) reconstruction has been investigated in a number of studies; however, no standard method has been established for postoperative analgesia after the reconstructive procedure. Regarding pain control following total knee arthroplasty (TKA), there have been a number of studies comparing different postoperative analgesic regimens, and periarticular injection is favorably rated among the measures in recent reports. By contrast, only a few studies have comparatively examined the efficacy of this mode of pain management after ACL reconstruction. Therefore, the aim of this study was to compare the effectiveness and safety of periarticular multimodal drug injection with those of femoral nerve block after ACL reconstruction.

Methods

A total of 57 patients (25 males, 32 females; age at the time of surgery, 26.9 ± 12.7 years) undergoing ACL reconstruction were enrolled in this study. Subjects were randomly divided into two groups with different pain control regimens: periarticular injection with multimodal drug (PI group; n = 31) and femoral nerve block (FNB group; n = 26). The PI group received a periarticular injection immediately before the end of surgery. The injection solution was made up of ropivacaine, morphine hydrochloride hydrate, methylprednisolone, ketoprofen, and epinephrine. The FNB group underwent an ultrasound-guided femoral nerve block with ropivacaine before the surgery. The ACL was reconstructed with the double-bundle procedure using autogenous semitendinosus tendon grafts. Postoperatively, intravenous patient-controlled analgesia (PCA) with fentanyl was administered as a supplemental measure.
For evaluation of postoperative pain, visual analog scale (VAS) scores were sequentially recorded for up to 2 weeks postoperatively, while the PCA (fentanyl) use in the 24-hour postoperative period was also checked. Additionally, C-reactive protein (CRP) levels at 1, 3, 7, and 14 days after surgery as well as intra perioperative complications were reviewed in the patient records and compared between the two groups.

Results

The VAS scores at 4, 8, 24 hours and 2 days after surgery were significantly lower in the PI group (p < 0.05). The amount of fentanyl used by PCA in the 24-hour postoperative period was 0.33 ± 0.25 mg and 0.56 ± 0.22 mg in the PI and FNB groups, respectively, indicating that the PI group used significantly less fentanyl (p < 0.05). The CRP level at 1 and 3 days was significantly lower in the PI group (p < 0.05). No problematic anesthetic-related or postoperative complication was encountered in either of the groups.

Discussion

Postoperative pain may substantially affect patients’ satisfaction of surgery. Moreover, adequate pain management can promote early functional recovery. In this study, it was shown that periarticular injection with multimodal drugs significantly reduced the intensity of postoperative pain as compared to the femoral nerve block, which is a popular method of pain management in our current practice. The interaction of multiple drugs included in the periarticular injection solution may have induced compound analgesic effects. As shown in other knee surgeries such as TKA, periarticular multimodal drug injection can be a valuable option as a pain control measure following ACL reconstruction.