Comparison of Analgesic Efficiency between Local Infiltration of a Long-Acting Analgesic and Regional Nerve Block among Patients Undergoing Arthroscopic Anterior Cruciate Ligament Reconstruction: Meta-Analysis of Randomized Controlled Trials.

Abstract

Background: Arthroscopic anterior cruciate ligament (ACL) reconstruction is gaining popularity. Different kinds of anesthetic techniques are used; however, regional nerve block (RNB) such as femoral nerve block is considered the most popular choice. The purpose of this study was to compare the effectiveness of long-acting local anesthesia infiltration (LAI) versus RNB used to control pain and reduce opioid consumption in patients undergoing arthroscopic ACL reconstruction.

Methods: We conducted a meta-analysis using a comprehensive literature search of Google Scholar, PubMed, Medline, and Cochrane Library. All randomized trials comparing the use of infiltration anesthesia versus RNB in patients undergoing arthroscopic ACL reconstruction were included. Methodological quality, risk of bias, and grade of the eligible studies were assessed by 3 independent reviewers. The risk of bias was analyzed using contour-enhanced funnel plots.

Results: The search yielded 671 records. Eight studies were included in the systematic review. The study focused on the assessment of immediate, 24-hour, and 48-hour postoperative pain scores and total opioid consumption. There was no significant difference between the use of LAI and RNB with regard to the immediate (p = 0.962), 24-hour (p = 0.156), and 48-hour postoperative pain scores (p = 0.216). The results suggested that LAI could lead to a similar level of opioid consumption as RNB (p = 0.304). However, there was considerable heterogeneity in the opioid consumption outcome due to the different anesthetic techniques used in the included studies.

Conclusions: Regarding postoperative pain control, LAI showed similar clinical effects when compared to the conventional RNB, while maintaining a similar level of opioid consumption postoperatively, decreasing the risk of any adverse effects of morphine. In summary, LAI offers a simpler method of achieving pain relief without the motor weakness associated with RNB. It also allows surgeons to perform ACL reconstruction in institutions without specialized anesthesia for RNB.