Local Infiltration Analgesia Versus Adductor Canal Block for Managing Pain After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis.

Abstract

Background: Adductor canal block (ACB) and local infiltration analgesia (LIA) are frequently used to manage pain in patients after anterior cruciate ligament reconstruction (ACLR).

Purpose: To compare the difference in pain scores and opioid consumption between ACB and LIA for ancillary pain management in patients after ACLR.

Study design: Systematic review; Level of evidence, 3.

Methods: A literature search was conducted using PubMed, MEDLINE, and Embase databases according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies that compared pain scores at 2, 6, 12, or 24 hours after ACLR or provided information on 24-hour opioid consumption were included. Of 240 publications initially screened by abstract and title, 4 studies were included, and data related to participant characteristics, anesthetic technique, and pain-related outcomes were extracted. The standardized mean difference (MD) in pain scores and morphine milligram equivalents consumed in 24 hours was compared using a random-effects model.

Results: In all studies, ropivacaine was the primary anesthetic used for LIA and ACB, with 1 study also employing bupivacaine as an alternative. The difference in pain scores between LIA and ACB was not significant at 2 hours (MD, 0.04 [95% CI, -0.22 to 0.29]; P = .79), 6 hours (MD, 0.16 [95% CI, -0.20 to 0.52]; P = .39), 12 hours (MD, 0.54 [95% CI, -0.49 to 1.56]; P = .31), or 24 hours (MD, 0.12 [95% CI, -0.10 to 0.34]; P = .28). The difference in morphine milligram equivalents was also not statistically significant (MD, -0.07 [95% CI, -0.25 to 0.11]; P = .68).

Conclusion: From this review, the authors suggest considering LIA over ACB because of its potential to offer comparable pain relief and opioid consumption while being less time intensive. However, the study results should be interpreted with caution, given the limited number of studies included.