Abstract | April 27, 2023
Multimodal Pain Management Strategies Following ACL Reconstruction: A Systematic Review
Learning Objectives
- To provide the best analgesic practices for clinicians to utilize to effectively manage patient’s pain after an ACL reconstructive procedure
- To understand the strengths and weaknesses of each analgesic regiment and recognize the variety of options available to tailor analgesia to the needs of each patient.
Introduction: Pain control after Anterior Cruciate Ligament Reconstruction (ACLR) is critical, as it influences postoperative recovery and the time to return to play. The purpose of this study was to evaluate multimodal pain management strategies following ACL reconstruction and to determine the impact on outcomes.
Methods: A systematic review of the literature was performed using PubMed, CINAHL and EMBASE in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta Analysis) guidelines. Studies that evaluated post-operative analgesia following ACLR were identified and were included if they were randomized control trials (RCTs) with one or more analgesic regimen being compared for efficacy. The following data were extracted: patient demographics, study design, analgesia regimens being compared, VAS scores, and study outcomes. Results: A total of 40 RCTs met inclusion criteria: 18 on regional nerve blocks (47%), 14 on intra-articular injections (34%), 3 on oral medications (7%), 3 on blood flow/ cryotherapy (7%), and 2 on IV infusions (5%). Adductor canal blocks (ACBs) provided an effective, but slightly less potent analgesia compared to femoral nerve blocks (FNB), which provided sufficient coverage for ACL reconstruction. ACBs in conjunction with popliteal plexus blocks can be advantageous in that there are no associated motor deficits compared to FNB. Additionally, pregabalin can be administered with an ACB to potentiate analgesia and reduce rescue opioid consumption in patients.
Conclusion: Preemptive administration of medications such as pregabalin or celecoxib along with intra-articular injections of morphine and bupivacaine in combination with adductor canal nerve blocks seem to be the most effective method for controlling pain following ACLR surgery. Orthopaedic surgeons should use multimodal analgesic strategies as the preferred method of inducing adequate analgesia following ACLR as differing mechanisms of actions of drugs provide a synergistic and more profound analgesia than one drug alone.
