Impact of Analgesic Modalities on Postoperative Breakthrough Pain Following Anterior Cruciate Ligament...

Effective postoperative pain management is vital for the recovery, mobility, and quality of life of patients undergoing anterior cruciate ligament reconstruction (ACLR) surgery. Our retrospective analysis aims to identify factors affecting postoperative breakthrough pain after ACLR, with a focus on analgesic modalities.

This retrospective study included 848 patients who underwent ACLR surgery at Peking University Third Hospital from January 1, 2019, to September 30, 2022. After applying exclusion criteria, patients were categorized into four groups: general anesthesia with femoral nerve block (Group G + F, n = 156), general anesthesia alone (Group G, n = 129), spinal anesthesia with femoral nerve block (Group S + F, n = 314), and spinal anesthesia alone (Group S, n = 249). The collected data included demographic details, analgesic methods, and the timing of the first pain relief request. Statistical analysis was performed using the chi-square test and multivariable logistic regression to evaluate intergroup differences and the effect of covariates.

A significant difference was found in the timing of the first analgesic request among the groups (p < 0.001). Group G and Group S requested their initial postoperative analgesics sooner than Groups G + F and S + F, respectively (p < 0.001). Multivariable analysis showed that gender was associated with postoperative breakthrough pain (odds ratio [OR] 0.502; 95% confidence interval [CI] 0.307 to 0.821). Postoperative routine use of non-steroidal anti-inflammatory drugs (NSAIDs) also reduced breakthrough pain incidence (OR 0.286; 95% CI 0.182 to 0.451). Breakthrough pain at 12 and 24 hours post-surgery was associated with prolonged hospital stays (p = 0.001 and 0.006, respectively).

The administration of a single-shot femoral nerve block (FNB) significantly delayed the first request for analgesia after ACLR, without leading to prolonged hospitalization. Factors associated with postoperative breakthrough pain during hospitalization included gender, regular NSAID use, and analgesic modality selection.