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Analgesic efficacy of ultrasound-guided adductor canal blockade after arthroscopic anterior cruciate ligament reconstruction: A randomised controlled trial

Espelund, Malene; Fomsgaard, Jonna S.; Haraszuk, Jørgen; Mathiesen, Ole; Dahl, Jørgen B.

European Journal of Anaesthesiology (EJA): July 2013 - Volume 30 - Issue 7 - p 422–428
doi: 10.1097/EJA.0b013e328360bdb9
Postoperative pain

CONTEXT Anterior cruciate ligament (ACL) reconstruction surgery is associated with moderate to severe postoperative pain, which may be ameliorated by peripheral nerve blocks. The adductor canal block (ACB) is an almost exclusively sensory nerve block that has been demonstrated to reduce pain and opioid consumption after major knee surgery.

OBJECTIVES To investigate the analgesic effect of ACB in patients receiving a basic analgesic regimen of paracetamol and ibuprofen after arthroscopic ACL reconstruction under general anaesthesia.

DESIGN Randomised, double-blind, placebo-controlled, parallel groups.

SETTING Day Case Surgery, University of Copenhagen, Glostrup Hospital, Denmark, June 2010 to March 2012.

PATIENTS Fifty patients, aged 18 to 70 years, scheduled for arthroscopic ACL reconstruction.

INTERVENTIONS Patients were randomised to receive ACB with either 30 ml ropivacaine 7.5 mg ml−1 (n = 25) or 30 ml 0.9% saline (n = 24).

MAIN OUTCOME MEASURES Primary outcome was pain score (0 to 100 mm) during standing at 2 h after surgery. Secondary outcomes were pain at rest, during standing and after walking 5 m, opioid consumption and opioid-related side effects for 24 h after surgery.

RESULTS Median (interquartile range) pain scores for the primary outcome were 20 (12 to 36) mm in the ropivacaine and 20 (10 to 44) mm in the control group (P = 0.84, 95% confidence interval for difference of −9 to 12 mm). No significant differences were observed in any of the secondary outcomes.

CONCLUSION An analgesic regimen with paracetamol and ibuprofen provides acceptable postoperative pain control after arthroscopic ACL reconstruction. ACB did not confer further benefit in our patients.

TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT01212666.

From the Department of Anaesthesiology (ME, JSF), Department of Orthopaedics, University of Copenhagen, Glostrup Hospital, Glostrup (JH), Section of Acute Pain Management, Copenhagen University Hospital (OM), Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Denmark (JBD)

Correspondence to Malene Espelund, Department of Anaesthesiology, University of Copenhagen, Glostrup Hospital, Nordre Ringvej 57, 2600 Glostrup, Denmark Tel: +45 3863 4178; e-mail: Espelund@dadlnet.dk

Published online 1 April 2013

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© 2013 European Society of Anaesthesiology