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Meta-Analysis
. 2025 Jun 6;26(1):565.
doi: 10.1186/s12891-025-08665-1.

Effectiveness and analgesic effect of local infiltration analgesia and femoral nerve block after anterior cruciate ligament reconstruction: a systematic review and meta-analysis

Wenjuan Ma #  1   2 , Dongmei Zhao #  2   3   4 , Pengcheng Li  5   6   7 , Li Liu  1   2 , Mingpeng Yang  1   2 , Jian Zhang  1   2 , Jian Li  8
Affiliations
Meta-Analysis

Effectiveness and analgesic effect of local infiltration analgesia and femoral nerve block after anterior cruciate ligament reconstruction: a systematic review and meta-analysis

Wenjuan Ma et al. BMC Musculoskelet Disord. .

Abstract

Background: Anterior cruciate ligament reconstruction (ACLR) is frequently associated with moderate to severe postoperative pain, necessitating effective analgesic strategies to enhance patient comfort and facilitate recovery. Identifying effective pain management methods after ACLR is crucial. This study aims to explore the best analgesia method with the local infiltration analgesia (LIA) and femoral nerve block (FNB) after ACLR.

Methods: Cochrane Library databases, PubMed, MEDLINE and Embase were searched from inception to April 2024 with the following terms: "anterior cruciate ligament" AND "reconstruction" AND "femoral nerve block" AND "local infiltration analgesia" AND "pain score" AND "morphine consumption" AND "analgesia duration" AND "complication".

Results: A total of 8 Level 1 randomized controlled trials (RCTs) were included in Meta analysis. The pain score of the FNB group was significantly lower than that of the LIA group at 8 to 12 h after the operation (MD = 1.78; 95% CI, [0.53, 3.03]; P = 0.005). There was no significant difference in pain scores between the two groups at 0 to 4, 4 to 8, and 12 to 24 h postoperatively. Within 24 h after surgery, there was no significant difference in intravenous morphine equivalent consumption between the two groups (MD = 3.76; 95% CI, [-0.82, 8.33]; P = 0.11). In terms of analgesic duration, there was also no significant difference between the two groups (MD = -3.03; 95% CI, [-7.34, 1.28]; P = 0.17). However, the incidence of nausea in the LIA group was higher than that in the FNB group (OR = 2.06; 95% CI, [1.03, 4.14]; P = 0.04).

Conclusion: The FNB is superior to LIA for intraoperative control of postoperative pain in the first 8 to 12 h after ACLR. But there was no significant difference in pain control at other time points, morphine consumption, and analgesic duration between the two groups within 24 h after surgery. The LIA group had a higher incidence of nausea within 24 h after surgery.

Keywords: Anterior cruciate ligament reconstruction; Femoral nerve block; Local infiltration analgesia; Pain.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The flowchart for inclusion in the study
Fig. 2
Fig. 2
Risk bias of the included trials
Fig. 3
Fig. 3
Summary of bias risk of the included trials
Fig. 4
Fig. 4
Pain scores at rest in 0 to 4 h, 4 to 8 h, 8 to 12 h, and 12 to 24 h postoperative period. FNB, femoral nerve block; LIA, local infiltration analgesia; IV, inverse variance
Fig. 5
Fig. 5
Intravenous (i.v.) morphine equivalent consumption, within 24 h postoperative period, mg
Fig. 6
Fig. 6
Duration of analgesia; hour
Fig. 7
Fig. 7
Nausea (complications) within 24 h postoperative period
See this image and copyright information in PMC

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