Adductor canal block versus intra-articular analgesia for postoperative pain after arthroscopic anterior cruciate ligament reconstruction: A randomized trial

Q2 Nursing

Perioperative Care and Operating Room Management Pub Date : 2025-01-08 DOI:10.1016/j.pcorm.2025.100466

Seham M. Moeen , Shaymaa R. Zarea , Mohamed H. Bakri , Hesham A. Elkady , Mohamed T. Mohamed , Mohamed A. Abdelsalam

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引用次数: 0

Abstract

Objectives

Optimal analgesia is crucial for promoting early rehabilitation and enhances functional recovery after arthroscopic anterior cruciate ligament reconstruction (ACLR). Our main objective was to compare the analgesic effectiveness of bupivacaine and dexamethasone administered in an adductor canal block (ACB) versus intra-articularly (IA) after ACLR. We hypothesized that the two approaches might have equal efficacy.

Methods

Seventy-two adult patients, ASA I–II, aged 18–65 years, undergoing elective ACLR under spinal anesthesia, were included in this randomized, double-blind, sham-controlled trial. Patients were randomly assigned to receive 18 ml of bupivacaine 0.25 % and 8 mg of dexamethasone either in ACB 30 min before spinal anesthesia or intra-articularly at the end of the surgery. Pain scores, both at rest and during movement, were assessed at 6, 12, 18, and 24 h after surgery. The time until the first analgesic request and the total analgesic consumption were recorded. Quadriceps muscle strength at 6 and 24 h after surgery, patient satisfaction, and any side effects were also recorded.

Results

The pain scores were significantly lower in the IA group at 12, 18, and 24 hrs after surgery, both at rest and during movement, with no patients requiring analgesia up to the first 17 hrs postoperatively. The times to the first ketorolac (1342.5 ± 132.7 versus 1167.5 ± 297.36 min, P= 0.029) and morphine (1412.5 ± 87.94 versus 1278.33 ± 274.04 min, P= 0.025) doses were significantly longer in the IA group compared to the ACB group. Kaplan-Meier curves for times to the first ketorolac and morphine doses showed significant differences (Breslow test) between the groups (P= 0.028 and P= 0.025, respectively). The total analgesic consumption was insignificantly lower in the IA group compared to the ACB group. Both groups had similar quadriceps muscle strength and patient satisfaction post-surgery, with no perioperative side effects observed.

Conclusions

The administration of bupivacaine plus dexamethasone for IA analgesia, compared to ACB, provided superior pain relief for up to 17 h following ACLR, both at rest and during movement.

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来源期刊

Perioperative Care and Operating Room Management Nursing-Medical and Surgical Nursing

CiteScore

1.30

自引率

0.00%

发文量

审稿时长

56 days

期刊介绍： The objective of this new online journal is to serve as a multidisciplinary, peer-reviewed source of information related to the administrative, economic, operational, safety, and quality aspects of the ambulatory and in-patient operating room and interventional procedural processes. The journal will provide high-quality information and research findings on operational and system-based approaches to ensure safe, coordinated, and high-value periprocedural care. With the current focus on value in health care it is essential that there is a venue for researchers to publish articles on quality improvement process initiatives, process flow modeling, information management, efficient design, cost improvement, use of novel technologies, and management.