Periarticular Local Infiltrative Anesthesia and Regional Adductor Canal Block Provide Equivalent Pain Relief After Anterior Cruciate Ligament Reconstruction.

Abstract Purpose To compare postoperative pain and recovery after anterior cruciate ligament reconstruction (ACLR) in patients who received an adductor canal block (ACB) or periarticular local infiltrative anesthesia (LIA). Methods A retrospective review of a prospectively collected ACL registry was performed. Patients underwent ACLR at a single institution between January 2015 and September 2020 and received long-acting local anesthesia with a pre-operative ultrasound-guided ACB or peri-articular LIA after surgery. Visual Analog Scale (VAS) pain scores, milligram morphine equivalents (MME) consumed in the post-anesthesia care unit (PACU), and total hospital recovery time were compared. Univariate analysis was used to compare VAS pain and MME totals between overall groups and groups propensity score matched for age, sex, BMI, graft type, and meniscal treatment. Results are presented as mean(95%CI) unless otherwise indicated. Results There were 265 knees (253 patients) included (LIA, 157 knees; ACB, 108 knees). Overall, VAS pain scores before hospital discharge (LIA 2.6 (2.4-2.8) vs. ACB 2.4 (2.1-2.7), p=0.334) and total MMEs were similar (LIA 17.6 (16.4-18.8) vs. ACB 18.5 (17.2-19.8) (MME), p=0.134). Median time to discharge also did not significantly differ (LIA 137.5 (IQR:116-178) vs. ACB 147 (IQR:123-183) (min), p=0.118). Matched sub-analysis (LIA and ACB, n=94) did not reveal significant differences in VAS pain before discharge (LIA 2.4 (2.1-2.7) vs ACB: 2.7 (2.4-3.0), p=0.134) or total MMEs (LIA 18.6 (17.2-20.0) vs. ACB 17.9 (16.4-19.4), p=0.520). Conclusion The use of ACB or LIA resulted in similar early pain levels, opioid consumption, and hospital recovery times after ACLR surgery.