Continuous femoral nerve block versus intra-articular injection for pain control after anterior cruciate ligament reconstruction.
BACKGROUND
Continuous femoral nerve blocks have been recommended for postoperative pain control after anterior cruciate ligament reconstruction.


OBJECTIVE
A pain control protocol involving a continuous ropivacaine femoral nerve block will decrease pain and narcotic use in the first 24 hours after surgery compared with a postoperative pain control protocol involving an intra-articular injection of bupivacaine/morphine.


METHODS
Randomized controlled clinical trial; Level of evidence, 2.


METHODS
Ninety subjects, aged 15 years or older, who were receiving arthroscopically assisted bone-patellar tendon-bone anterior cruciate ligament reconstruction were randomly assigned to 2 groups. The first group received a ropivacaine continuous femoral nerve block and oral hydrocodone (block group). The second group received an intra-articular bupivacaine/morphine injection and oral oxycodone (injection group). Patients in both groups could receive intramuscular injection of hydromorphone for breakthrough pain; most patients in the block group also received bolus doses of ropivacaine through the femoral catheter. Subjects rated their worst, average, and current pain levels using a visual analog scale and category-ratio scale the morning after surgery. Postoperative narcotic pain medication use was converted to morphine-equivalent doses.


RESULTS
Postoperative pain ratings did not differ between the treatment groups. The largest difference in pain ratings between the groups was 0.5 cm for worst pain level (P = .345). Total narcotic use did not differ significantly between groups (1.1 morphine-equivalent doses in both groups; P = .671).


CONCLUSIONS
Continuous femoral block with ropivacaine appeared to have no clinical advantage in the immediate postoperative period after anterior cruciate ligament reconstruction when compared with an intra-articular injection of bupivacaine/morphine. Both methods are effective for pain control after anterior cruciate ligament reconstruction.
Woods
G William
GW
Fondren Orthopedic Group, Texas Orthopedic Hospital, 7401 South Main Street, Houston, TX 77030-4509, USA.
O'Connor
Daniel P
DP
Calder
Cynthia T
CT
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000577:Amides / Q000008:administration & dosage; D000704:Analysis of Variance; D000779:Anesthetics, Local / Q000008:administration & dosage*; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001182:Arthroscopy; D050376:Bone-Patellar Tendon-Bone Grafting; D004359:Drug Therapy, Combination; D005260:Female; D005267:Femoral Nerve; D006801:Humans; D006853:Hydrocodone / Q000008:administration & dosage; D007270:Injections, Intra-Articular; D007273:Injections, Intramuscular; D008297:Male; D009020:Morphine / Q000008:administration & dosage; D009294:Narcotics / Q000008:administration & dosage; D009407:Nerve Block; D010098:Oxycodone / Q000008:administration & dosage; D010147:Pain Measurement; D010149:Postoperative Pain / Q000628:therapy*; D017060:Patient Satisfaction; D000077212:Ropivacaine; D012421:Rupture / Q000601:surgery; D016896:Treatment Outcome
D000577:Amides; D000779:Anesthetics, Local; D009294:Narcotics; D006853:Hydrocodone; D009020:Morphine; D000077212:Ropivacaine; D010098:Oxycodone