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Background and Aims Anterior cruciate ligament reconstruction (ACLR) is associated with moderate to severe postoperative pain, so effective analgesia is necessary for patient satisfaction, early discharge and functional recovery. Although the use of regional techniques is widely accepted, the choice remains controversial. We compare adductor canal block (ACB) versus femoral nerve block (FNB) in our clinical practice.
Methods A descriptive observational retrospective study was designed and its approval by IRB was requested (IIBSP-LCA-2023-67). We included 32 patients that underwent ambulatory ACLR between 2021 and 2022 at our hospital. Anaesthetic techniques, time to discharge and postoperative pain (NPRS) were collected.
Results The most used anaesthetic technique was spinal anaesthesia combined with ACB (table 1). Peripheral nerve blocks were performed with 0.2% ropivacaine. 68.8% of patients received perineural or intravenous corticosteroids, and all patients received intravenous paracetamol and dexketoprofen before surgical incision. There was no difference between ACB and FNB when pain was measured in the immediate postoperative (NPRS 0.95 vs 1.17; p=0.79) or at 24 hours (NPRS 2.80 vs 3.00; p=0.88) (figure 1). The mean hospital discharge time was 292 minutes (SD=71), with no differences between spinal and general anaesthesia (p=0.31) or between regional techniques (p=0.47).
Conclusions ACB and FNB are equally efficacious and the mainstay treatment of postoperative pain after ACLR, as a part of multimodal approach. ACB decreases risk of quadriceps weakness although with low concentration of long-acting local anaesthetic (0.2% ropivacaine) we did not observe prolonged residual motor blockade with FNB. No complications related to regional anaesthesia were reported.
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