Femoral Nerve Block and Local Instillation Analgesia Associated With More Reliable Efficacy in Regional Anesthesia Interventions Within 24 Hours Following Anterior Cruciate Ligament Reconstruction: A Network Meta-analysis

Hongzhi Liu; Xinqiu Song; Chuiqing Li; Yan Li; Wanshou Guo; Hongmei Zhang

doi:10.1016/j.arthro.2022.12.014

Femoral Nerve Block and Local Instillation Analgesia Associated With More Reliable Efficacy in Regional Anesthesia Interventions Within 24 Hours Following Anterior Cruciate Ligament Reconstruction: A Network Meta-analysis

Arthroscopy. 2023 May;39(5):1273-1295. doi: 10.1016/j.arthro.2022.12.014. Epub 2023 Jan 26.

Authors

Hongzhi Liu¹, Xinqiu Song², Chuiqing Li³, Yan Li¹, Wanshou Guo⁴, Hongmei Zhang⁵

Affiliations

¹ Department of Orthopaedics, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
² Yan'an University, Yan'an, Shaanxi, China.
³ Weifang Traditional Chinese Hospital, Weifang, Shandong, China.
⁴ Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China.
⁵ Department of Orthopaedics, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China. Electronic address: wangjingzhm@sina.com.

PMID: 36708747
DOI: 10.1016/j.arthro.2022.12.014

Abstract

Purpose: To assess the relative effectiveness of different regional anesthetic techniques (peripheral nerve blocks, local instillation analgesia, including intra-articular, subcutaneous, and periarticular infiltration) in patients undergoing anterior cruciate ligament reconstruction (ACLR).

Methods: PubMed, Embase, Cochrane Library, and Web of Science databases were searched from their inception to December 31, 2020. The search was supplemented by manual review of relevant reference lists. Randomized controlled trials of participants after ACLR that compared regional anesthesia interventions were selected. The 2 coprimary outcomes were (1) rest pain scores and (2) cumulative oral morphine equivalent consumption on day 1 (24 hours) post-ACLR. Data were pooled using a Bayesian framework.

Results: Of 759 records identified, 46 trials were eligible, evaluating 9 interventions in 3,171 patients. Local instillation analgesia (LIA), including intra-articular, subcutaneous, and periarticular infiltration, had significant improvement in pain relief as compared with placebo (-0.91; 95% CrI -1.45 to -0.37). Femoral nerve block (FNB) also showed significant effects in relieving pain as compared with placebo (-0.70; 95% 95% credible interval [CrI] -1.28 to -0.12). Compared with placebo, a significant reduction in opioid consumption was found in LIA (mean difference -13.29 mg; 95% CrI -21.77 to -4.91) and FNB (mean difference -13.97 mg; 95% CrI -24.71 to -3.04). Femoral and sciatic nerve block showed the greatest ranking for pain relief and opioid consumption without significant evidence (P > .05) to support superiority in comparison with placebo, respectively.

Conclusions: Our meta-analysis shows that FNB and LIA can significantly diminish postoperative pain and reduce opioid consumption following ACLR compared with placebo in the setting of regional anesthesia, and femoral and sciatic nerve block may be the number 1 top-ranked analgesic technique despite high uncertainty.

Level of evidence: I, Systematic review of Level I studies.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Analgesia* / methods
Analgesics, Opioid / therapeutic use
Anesthesia, Conduction*
Anterior Cruciate Ligament Reconstruction* / methods
Bayes Theorem
Femoral Nerve
Humans
Nerve Block* / methods
Network Meta-Analysis
Pain, Postoperative / drug therapy

Substances

Analgesics, Opioid