Effectiveness and analgesic effect of local infiltration analgesia and femoral nerve block after anterior cruciate ligament reconstruction: a systematic review and meta-analysis.

Abstract

Background: Anterior cruciate ligament reconstruction (ACLR) is frequently associated with moderate to severe postoperative pain, necessitating effective analgesic strategies to enhance patient comfort and facilitate recovery. Identifying effective pain management methods after ACLR is crucial. This study aims to explore the best analgesia method with the local infiltration analgesia (LIA) and femoral nerve block (FNB) after ACLR.

Methods: Cochrane Library databases, PubMed, MEDLINE and Embase were searched from inception to April 2024 with the following terms: "anterior cruciate ligament" AND "reconstruction" AND "femoral nerve block" AND "local infiltration analgesia" AND "pain score" AND "morphine consumption" AND "analgesia duration" AND "complication".

Results: A total of 8 Level 1 randomized controlled trials (RCTs) were included in Meta analysis. The pain score of the FNB group was significantly lower than that of the LIA group at 8 to 12 h after the operation (MD = 1.78; 95% CI, [0.53, 3.03]; P = 0.005). There was no significant difference in pain scores between the two groups at 0 to 4, 4 to 8, and 12 to 24 h postoperatively. Within 24 h after surgery, there was no significant difference in intravenous morphine equivalent consumption between the two groups (MD = 3.76; 95% CI, [-0.82, 8.33]; P = 0.11). In terms of analgesic duration, there was also no significant difference between the two groups (MD = -3.03; 95% CI, [-7.34, 1.28]; P = 0.17). However, the incidence of nausea in the LIA group was higher than that in the FNB group (OR = 2.06; 95% CI, [1.03, 4.14]; P = 0.04).

Conclusion: The FNB is superior to LIA for intraoperative control of postoperative pain in the first 8 to 12 h after ACLR. But there was no significant difference in pain control at other time points, morphine consumption, and analgesic duration between the two groups within 24 h after surgery. The LIA group had a higher incidence of nausea within 24 h after surgery.