CC2021: Contribution of Multimodal Analgesia to Postoperative Pain Outcomes Immediately After Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Level 1 Randomized Clinical Trials (September 2021)-CC2021: Contribution of Multimodal Analgesia to Postoperative Pain Outcomes Immediately After Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Level 1 Randomized Clinical Trials (September 2021)

CC2021: Contribution of Multimodal Analgesia to Postoperative Pain Outcomes Immediately After Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Level 1 Randomized Clinical Trials (September 2021)

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This systematic review and meta-analysis examined the contribution of multimodal analgesia to postoperative pain outcomes immediately after primary anterior cruciate ligament (ACL) reconstruction. The study reviewed 27 level 1 randomized clinical trials that compared postoperative pain scores, opioid consumption, and complications in patients receiving spinal anesthesia, adjunct regional nerve blocks, or local analgesics.<br /><br />The findings of the study showed that pain control after primary ACL reconstruction based on visual analog scale (VAS) scores was significantly improved at 8 to 12 hours in patients receiving regional anesthesia compared to spinal anesthesia. VAS scores were also significantly lower at 12 to 24 hours in patients receiving femoral nerve block (FNB) compared to adductor canal block (ACB) and those treated with continuous FNB rather than single-shot regional blocks (FNB, ACB) at 12 to 24 hours.<br /><br />There was no significant difference in VAS scores when comparing spinal, regional, and local anesthesia groups at 12 to 24 hours after surgery. The study also found that opioid consumption was lower in patients receiving regional anesthesia, although the limited number of studies did not allow for meaningful statistical analysis.<br /><br />It is important to note that the heterogeneity in anesthetic and analgesic protocols and the variability of medications used in conjunction with the blocks were limitations of the study. Additionally, the study did not evaluate the minimum clinically important difference in pain reduction or the influence of other factors such as complications and length of surgery.<br /><br />In conclusion, the study suggests that multimodal analgesia, particularly regional anesthesia, contributes to better pain control outcomes after primary ACL reconstruction. However, more research is needed to assess the long-term effects and complications associated with different types of anesthesia.<br /><br />Original Article:<br />Maheshwer B, Knapik DM, Polce EM, Verma NN, LaPrade RF, Chahla J. Contribution of Multimodal Analgesia to Postoperative Pain Outcomes Immediately after Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Level 1 Randomized Clinical Trials. The American Journal of Sports Medicine. 2021;49(6):1605-1615. doi:10.1177/0363546520980429

Keywords

systematic review

meta-analysis

multimodal analgesia

postoperative pain outcomes

anterior cruciate ligament reconstruction

spinal anesthesia

regional nerve blocks

local analgesics

visual analog scale

opioid consumption