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Periarticular injection and hamstring block versus placebo for pain control in anterior cruciate ligament
Joaquín De Lamo-Rovira1, Francisco López-Caba2, Juan Giménez-Giménez2
1Department of Orthopaedics, Virgen de La Luz Hospital, Hermandad Donantes de Sangre street, 16004, Cuenca, Spain. drjlamo@hotmail.com.
Purpose:
To study the effectiveness of periarticular infiltration (PI), including the proximal donor site vs. placebo in anterior cruciate ligament (ACL) reconstruction.
Method:
A total of 44 patients were randomized in two groups assigned to receive PI or placebo. The perioperative protocol was the same for both groups. The principal outcome was pain measured at 8 and 24 h by a visual analog scale (VAS). The pain was registered in the knee and the proximal donor site. Pain scores were also assessed to determine whether the VAS improvement would reach the threshold values reported for the minimal clinically significant difference. The secondary outcome was the need for opioid rescue medication.
Results:
Patients receiving PI exhibited lower pain values in the knee at 8 h (mean PI 35.00 ± 5.76 vs. placebo 60.23 ± 4.52 p = 0.01) and at 24 h (mean PI 37.23 ± 5.62 vs. placebo 55.55 ± 3.41 p = 0.008). These results were above the threshold for clinical significance. No improvements were found in proximal donor site pain and consumption of opioid rescue medication. Complications were comparable between the two groups.
Conclusion:
PI significantly reduced pain in the knee vs. placebo after ACL reconstruction with hamstring autograft at 8 and 24 h after surgery. The instillation of part of the mixture in the proximal hamstring stump did not result in any improvement LEVEL OF EVIDENCE I: Level I, randomized controlled trial.
