Evidence Basis for Regional Anesthesia in Ambulatory Anterior Cruciate Ligament Reconstruction: Part I-Femoral Nerve Block
- PMID: 29596099
- DOI: 10.1213/ANE.0000000000002854
Evidence Basis for Regional Anesthesia in Ambulatory Anterior Cruciate Ligament Reconstruction: Part I-Femoral Nerve Block
Abstract
The optimal management of pain after ambulatory anterior cruciate ligament reconstruction (ACLR) is unclear. Femoral nerve block (FNB) is purported to enhance postoperative analgesia, but its effectiveness in the setting of modern multimodal analgesia is unclear. This systematic review examines the effect of adding FNB to multimodal analgesia on analgesic outcomes after ACLR, whether or not the analgesic regimen used included local instillation analgesia (LIA). We retrieved randomized controlled trials evaluating the effects of adding FNB to multimodal analgesia on analgesic outcomes after ACLR, compared to multimodal analgesia alone (control). We designated postoperative opioid consumption at 24 hours as our primary outcome. Secondary outcomes included postoperative opioid consumption at 24-48 hours, rest, and dynamic pain severity between 0 and 48 hours, time to analgesic request, postanesthesia care unit and hospital stay durations, patient satisfaction, postoperative nausea and vomiting, functional outcomes, and long-term (>1 month) quadriceps strength. Eight randomized controlled trials (716 patients) were identified. Five trials compared FNB administration to control, and another 3 compared the combination of FNB and LIA to LIA alone. Compared to control, adding FNB resulted in modest reductions in 24-hour opioid consumption in 2 of 3 trials, and improvements in rest pain at 1 hour in 1 trial and up to 24 hours in another. In contrast, the combination of FNB and LIA, compared to LIA alone, did not reduce opioid consumption in any of the trials, but it did improve pain scores at 20 minutes only in 1 trial. The effect of FNB on long-term quadriceps strength or function after ACLR was not evaluated in the reviewed trials. Contemporary evidence suggests that the benefits of adding FNB to multimodal analgesia for ACLR are modest and conflicting, but there is no incremental analgesic benefit if the multimodal analgesic regimen included LIA. Our findings do not support the routine use of FNB for analgesia in patients having ACLR.
Comment in
-
Are Peripheral Nerve Blocks Indicated in Ambulatory Knee Surgery?Anesth Analg. 2019 Jan;128(1):3-4. doi: 10.1213/ANE.0000000000003646. Anesth Analg. 2019. PMID: 30550466 No abstract available.
Similar articles
-
Evidence Basis for Regional Anesthesia in Ambulatory Anterior Cruciate Ligament Reconstruction: Part III: Local Instillation Analgesia-A Systematic Review and Meta-analysis.Anesth Analg. 2019 Mar;128(3):426-437. doi: 10.1213/ANE.0000000000002599. Anesth Analg. 2019. PMID: 29200071
-
Effectiveness and analgesic effect of local infiltration analgesia and femoral nerve block after anterior cruciate ligament reconstruction: a systematic review and meta-analysis.BMC Musculoskelet Disord. 2025 Jun 6;26(1):565. doi: 10.1186/s12891-025-08665-1. BMC Musculoskelet Disord. 2025. PMID: 40474133 Free PMC article.
-
Evidence Basis for Regional Anesthesia in Ambulatory Arthroscopic Knee Surgery and Anterior Cruciate Ligament Reconstruction: Part II: Adductor Canal Nerve Block-A Systematic Review and Meta-analysis.Anesth Analg. 2019 Feb;128(2):223-238. doi: 10.1213/ANE.0000000000002570. Anesth Analg. 2019. PMID: 29064877
-
Adductor Canal Versus Femoral Nerve Block after Anterior Cruciate Ligament Reconstruction: A Systematic Review of Level I Randomized Controlled Trials Comparing Early Postoperative Pain, Opioid Requirements, and Quadriceps Strength.Arthroscopy. 2020 Jul;36(7):1973-1980. doi: 10.1016/j.arthro.2020.03.040. Epub 2020 Apr 18. Arthroscopy. 2020. PMID: 32315764
-
Combined preoperative femoral and sciatic nerve blockade improves analgesia after anterior cruciate ligament reconstruction: a randomized controlled clinical trial.J Clin Anesth. 2016 Sep;33:68-74. doi: 10.1016/j.jclinane.2016.02.021. Epub 2016 Apr 29. J Clin Anesth. 2016. PMID: 27555136 Clinical Trial.
Cited by
-
Postoperative Pain Control After ACL Reconstruction With Semitendinosus Tendon Graft: A Randomized Controlled Trial Comparing Adductor Canal Block to Local Infiltration Analgesia.Orthop J Sports Med. 2024 Nov 15;12(11):23259671241292604. doi: 10.1177/23259671241292604. eCollection 2024 Nov. Orthop J Sports Med. 2024. PMID: 39555324 Free PMC article.
-
Benefits of Implementing an Enhanced Recovery After Surgery Protocol in Ambulatory Surgery.Orthop J Sports Med. 2022 Nov 23;10(11):23259671221133412. doi: 10.1177/23259671221133412. eCollection 2022 Nov. Orthop J Sports Med. 2022. PMID: 36452342 Free PMC article.
-
Managing Perioperative Pain After Anterior Cruciate Ligament (ACL) Reconstruction: Perspectives from a Sports Medicine Surgeon.Open Access J Sports Med. 2021 Sep 4;12:129-138. doi: 10.2147/OAJSM.S266227. eCollection 2021. Open Access J Sports Med. 2021. PMID: 34512045 Free PMC article. Review.
-
Resolution of Pain and Predictors of Postoperative Opioid use after Bridge-Enhanced Anterior Cruciate Ligament Repair and Anterior Cruciate Ligament Reconstruction.Arthrosc Sports Med Rehabil. 2020 May 14;2(3):e219-e228. doi: 10.1016/j.asmr.2020.02.004. eCollection 2020 Jun. Arthrosc Sports Med Rehabil. 2020. PMID: 32548587 Free PMC article.
-
Peripheral Nerve Blockade for Medial Patellofemoral Ligament Reconstruction in Pediatric Patients: The Addition of a Proximal Single-Injection Sciatic Nerve Block Provides Improved Analgesia.Local Reg Anesth. 2022 Jun 27;15:31-43. doi: 10.2147/LRA.S360738. eCollection 2022. Local Reg Anesth. 2022. PMID: 35782524 Free PMC article.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical