title: Pain management by periarticular multimodal drug injection after anterior cruciate ligament reconstruction: a randomized, controlled study.
abstract: OBJECTIVE
  We aimed to determine the efficacy of periarticular (PA) multimodal drug cocktail (MDC) infiltration for pain control after anterior cruciate ligament reconstruction with an autogenous bone-patellar tendon-bone graft.
  
  
  METHODS
  We randomly assigned 100 patients to five study groups (20 per group): control group, no injection; intra-articular (IA) ropivacaine group, IA injection of ropivacaine alone; IA MDC group, IA injection of MDC; PA MDC group, PA injection of MDC; and IA + PA MDC group, IA and PA injections of MDC. The MDC consisted of ropivacaine, morphine, ketorolac, epinephrine, and cefuroxime. The five groups were compared in terms of pain levels during the first night after surgery and on postoperative days 1, 2, and 14; patient satisfaction was assessed on postoperative day 14.
  
  
  RESULTS
  The PA MDC and IA + PA MDC groups had less pain during the first night than patients in the other three groups (P < .001) and were more likely to have the same amount of pain or less pain on postoperative day 1 than their preoperative expectation (P = .05). However, there were no group differences in patient satisfaction on postoperative day 14. No MDC-related side effect was reported.
  
  
  CONCLUSIONS
  The MDC injection, particularly when delivered periarticularly, provides an effective, safe means of reducing early postoperative pain after anterior cruciate ligament reconstruction at minimal cost. In addition, a single IA injection would have no value in pain relief, regardless of types of drugs.
  
  
  METHODS
  Level I, randomized controlled trial.
authors.affiliation: Department of Orthopaedic Surgery, Uijeongbu St. Mary's Hospital, Uijeongbu, South Korea.
authors.forename: In Jun
authors.initials: IJ
authors.lastname: Koh
authors.forename: Chong Bum
authors.initials: CB
authors.lastname: Chang
authors.forename: Eun Seok
authors.initials: ES
authors.lastname: Seo
authors.forename: Sung Ju
authors.initials: SJ
authors.lastname: Kim
authors.forename: Sang Cheol
authors.initials: SC
authors.lastname: Seong
authors.forename: Tae Kyun
authors.initials: TK
authors.lastname: Kim
mesh_terms: D000328:Adult; D000577:Amides / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000627:therapeutic use*; D059549:Anterior Cruciate Ligament Reconstruction; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D050376:Bone-Patellar Tendon-Bone Grafting; D002444:Cefuroxime / Q000627:therapeutic use; D004338:Drug Combinations; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D020910:Ketorolac / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D000077212:Ropivacaine; D016037:Single-Blind Method; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D004338:Drug Combinations; D014662:Vasoconstrictor Agents; D009020:Morphine; D000077212:Ropivacaine; D002444:Cefuroxime; D004837:Epinephrine; D020910:Ketorolac