The purpose of this study is to systematically review the randomized controlled trials (RCTs) that evaluate various pain control interventions post-anterior cruciate ligament reconstruction (ACLR), in order to determine the best-available evidence in managing post-operative pain and optimize patient outcomes.
A systematic review of the literature was performed based on the PRISMA guidelines. Studies were included if they were an RCT evaluating an intervention to reduce post-operative pain acutely after ACLR, on one of the following areas; (1) nerve blocks, (2) nerve block adjuncts, (3) intra-articular injections, (4) oral medications, (5) intra-venous medications, (6) tranexamic acid (TXA), and (7) compressive stockings and cryotherapy. Quantitative and qualitative statistics were carried out, and network meta-analysis was performed where applicable.
Overall, 74 RCTs were included. Across 34 studies, nerve blocks were found to significantly reduce post-operative pain and opioid use, but there was no significant difference between the various nerve blocks in the network meta-analysis. Intra-articular injections consisting of bupivacaine and an adjunct were found to reduce reported post-operative pain scores up to 12 hours post-ACLR, with significantly lower post-operative opioid use.
Nerve blocks and regional anesthesia are the mainstay treatment of post-operative pain following ACLR, with the commonly used nerve blocks being equally efficacious. Intra-articular injections consisting of bupivacaine and an adjunct were found to reduce reported post-operative pain scores up to 12 hours post-ACLR, with significantly lower post-operative opioid use. There was promising evidence for the use of some oral and IV medications, TXA, nerve block adjuncts as well as cryotherapy to control pain and reduce post-operative opioid use.
Level of Evidence II, Systematic Review & Meta-Analysis of Randomized Control Trials.