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Br J Anaesth. 2019 Aug;123(2):e343-e349. doi: 10.1016/j.bja.2019.04.053. Epub 2019 May 24.

Adductor canal block versus local infiltration analgesia for postoperative pain after anterior cruciate ligament reconstruction: a single centre randomised controlled triple-blinded trial.

Author information

1
Department of Anaesthesia, Lausanne University Hospital, Lausanne, Switzerland.
2
Department of Orthopaedic, Lausanne University Hospital, Lausanne, Switzerland.
3
Department of Anaesthesia, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada.
4
Department of Anaesthesia, Lausanne University Hospital, Lausanne, Switzerland. Electronic address: eric.albrecht@chuv.ch.

Abstract

BACKGROUND:

Both the adductor canal block (ACB) and local infiltration analgesia (LIA) are effective analgesic techniques after anterior cruciate ligament (ACL) reconstruction, but they have never been compared head-to-head. This randomised controlled triple-blinded trial tested the hypothesis that ACB provides superior analgesia to LIA after ACL reconstruction, with additional focus on postoperative functional outcomes.

METHODS:

Of 104 enrolled ACL reconstruction patients receiving general anaesthesia, 52 were randomly allocated to either ACB under ultrasound guidance or LIA. For each intervention, ropivacaine 0.5%, 20 ml was injected. Postoperative pain treatment followed a predefined protocol with i.v. patient-controlled morphine, paracetamol, and ibuprofen. The primary outcome was cumulative i.v. morphine consumption at 24 h after operation. Secondary pain-related outcomes included resting and dynamic pain scores (numeric rating scale out of 10) measured 2, 24, and 48 h after operation and cumulative i.v. morphine consumption 2 and 48 h after operation. Early function-related outcomes evaluated were quadriceps strength, walking distance, and range of motion, all measured 24 and 48 h after operation. Late function-related outcomes were concentric quadriceps strength, single-hop test, triple-hop test, cross-over test, and Y balance test, measured at 4 and 8 postoperative months.

RESULTS:

Cumulative i.v. morphine consumption at 24 h was similar between groups (ACB group: 17.1 mg [95% confidence interval, CI: 13.1, 21.2]; LIA group: 17.7 mg [95% CI: 13.2, 22.6], P=0.84). Similarly, no differences between groups were seen in the secondary pain- or function-related outcomes.

CONCLUSIONS:

ACB and LIA result in equivalent postoperative opioid consumption with similar impact on postoperative pain scores and functional outcomes.

CLINICAL TRIAL REGISTRATION:

NCT02524652.

KEYWORDS:

anterior cruciate ligament reconstruction; local infiltration analgesia; postoperative analgesia; regional anaesthesia; ropivacaine

PMID:
31130273
PMCID:
PMC6676236
DOI:
10.1016/j.bja.2019.04.053
[Indexed for MEDLINE]
Free PMC Article

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