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Posterior capsule injection of local anesthetic for post-operative pain control after ACL reconstruction: a prospective, randomized trial

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Alternative modalities to optimize pain control after anterior cruciate ligament reconstruction (ACLR) are continually being explored. The purpose of this study was to compare femoral nerve block (FNB) only vs FNB with posterior capsule injection (PCI) of the knee for pain control in patients undergoing ACLR.

Methods

Patients undergoing primary ACLR were randomized to receive either FNB only or FNB with PCI. Following surgery, patient’s pain was evaluated in the postoperative care unit (PACU) and at home for 4 days. Pain levels were measured via visual analog scale (VAS) and calculating opioid consumption. Outcomes of interest included postoperative pain levels and opioid consumption.

Results

A total of 42 patients were evaluated, with 21 patients randomized to each study arm. Outcomes showed significant pain reduction in both anterior and posterior knee VAS scores in the PACU in those that received PCI (anterior VAS: 39.6 vs 21.3 (SD = 12.9), p < 0.01; posterior VAS: 25.4 vs 15.3 (SD = 8.05), p = 0.01). Moreover, the PCI group also showed significantly less opioid consumption compared to FNB only (23.5 vs 17.4 pills, p = 0.03). There were no differences found in pain scores between groups in home VAS sores.

Conclusions

These finding suggest the use of arthroscopically assisted injection of local anesthetic to the posterior capsule of the knee significantly reduces early post-operative pain and dramatically reduces the number of opoid medication taken after ACLR.

Level of evidence

Prospective, randomized, control trial, Level I.

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Funding

No external funding was used for this project.

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Authors and Affiliations

  1. Ascension Crittenton Hospital, 1101 W. University Rd, Rochester, MI, 48307, USA

    Robert A. Keller

  2. Premier Orthopaedics, 2004 Sproul Road, Broomall, PA, 19008, USA

    Michael E. Birns

  3. Kerlan-Jobe Orthopaedic Clinic, 6801 Park Terrace Dr, Los Angeles, CA, 90045, USA

    Adam C. Cady, Orr Limpisvasti & Michael B. Banffy

Authors
  1. Robert A. Keller
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  2. Michael E. Birns
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  3. Adam C. Cady
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  4. Orr Limpisvasti
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  5. Michael B. Banffy
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Corresponding author

Correspondence to Robert A. Keller.

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Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable standards.

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Keller, R.A., Birns, M.E., Cady, A.C. et al. Posterior capsule injection of local anesthetic for post-operative pain control after ACL reconstruction: a prospective, randomized trial. Knee Surg Sports Traumatol Arthrosc 27, 822–826 (2019). https://doi.org/10.1007/s00167-018-5111-3

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  • DOI: https://doi.org/10.1007/s00167-018-5111-3

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