title: Local infiltration analgesia is comparable to femoral nerve block after anterior cruciate ligament reconstruction with hamstring tendon graft: a randomised controlled trial.
abstract: OBJECTIVE
  Arthroscopic anterior cruciate ligament (ACL) reconstruction is a painful procedure requiring intensive postoperative pain management. Femoral nerve block is widely used in ACL surgery. However, femoral nerve block does not cover the donor site of the hamstring tendons. Local infiltration analgesia is a simple technique that has proven effective in postoperative pain management after total knee arthroplasty. Further, local infiltration analgesia covers the donor site and is associated with few complications. It was hypothesised that local infiltration analgesia at the donor site and wounds would decrease pain and opioid consumption after ACL reconstruction with hamstring tendon graft.
  
  
  METHODS
  Sixty patients undergoing primary ACL surgery with hamstring tendon graft were randomised to receive either local infiltration analgesia or femoral nerve block. Pain was scored on the numeric rating scale, and use of opioid, range of motion and adverse effects were assessed at the postoperative recovery unit (0 h), 3, 24 and 48 h, postoperatively.
  
  
  RESULTS
  There were no significant differences between the groups in pain intensity or total opioid consumption at any of the follow-up points. Further, there were no differences between groups concerning side effects and range of motion.
  
  
  CONCLUSIONS
  Local infiltration analgesia and femoral nerve block are similar in the management of postoperative pain after ACL reconstruction with hamstring tendon graft. Until randomised studies have investigated femoral nerve block combined with infiltration at the donor site, we recommend local infiltration analgesia in ACL reconstruction with hamstring tendon graft.
authors: Department of Orthopedic Surgery, Region Hospital Horsens, Sundvej 30, Horsens, Denmark, pia.kjar.kristensen@horsens.rm.dk.
authors: Pia Kjær
authors: PK
authors: Kristensen
authors: Mogens
authors: M
authors: Pfeiffer-Jensen
authors: Jens Ole
authors: JO
authors: Storm
authors: Theis Muncholm
authors: TM
authors: Thillemann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000577:Amides / Q000627:therapeutic use; D000772:Anesthesia, Local; D000779:Anesthetics, Local / Q000627:therapeutic use; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D001182:Arthroscopy; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D005267:Femoral Nerve; D005500:Follow-Up Studies; D006801:Humans; D007718:Knee Injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal; D009407:Nerve Block; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control*; D000077212:Ropivacaine; D016037:Single-Blind Method; D013710:Tendons / Q000637:transplantation*; D016896:Treatment Outcome
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D004837:Epinephrine