Anterior cruciate ligament (ACL) reconstruction is one of the most commonly performed surgeries amongst young orthopedic surgery patients. Optimal post-operative pain control helps to reduce the opioid burden and to improve the patient's experience. Regional anesthesia, such as the femoral nerve block (FNB) and adductor canal block (ACB), are commonly used for post-operative pain control after surgery. The ACB has replaced the FNB. This is because the ACB targets the femoral nerve, while avoiding the numbing effects on quadricep muscle strength that make it difficult to move the leg. Another form of pain control is local infiltration anesthesia (LIA), which directly blocks pain in the knee. Similar to the ACB, it avoids the numbing effects on the quadricep muscle.This can help improve patient safety and experience by reducing risks of falls and allowing the patient to move earlier. This can also be associated with decreased time in the hospital and decreased costs. Technically, it is less complex and can be done the shorter period of time. The purpose of this study is to refine the pain management technique following anterior cruciate ligament surgery. More specifically, the aim of this study is to evaluate the effects of LIA alone, and a LIA-ACB combination on post-operative pain and thigh muscle strength.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
100
For the local infiltration anesthetic, patients will receive 20 cc of 0.5% ropivacaine, by intra-articular injection performed by the surgeon. The injection is done at the end of the surgical procedure, after suturing the incision.
For the local infiltration anesthetic, patients will receive 20 cc of 0.25% ropivacaine, by intra-articular injection performed by the surgeon. The injection is done at the end of the surgical procedure, after suturing the incision. For the adductor canal block, patients will receive 20 cc of 0.25% ropivicaine, through injection performed by the anesthesiologist. The injection is done under the sartorius muscle, in mid-thigh, using ultrasound guidance.
Oral morphine equivalent consumption
Cumulative oral morphine equivalent consumption over 24 hours post-op
Time frame: Up to 24-hours after surgery
Quadriceps motor strength
Percent decrease in quadriceps motor strength at 30 minutes following anesthesia compared to baseline
Time frame: Pre-op, 30 minutes post-anesthesia
inta-operative opioid consumption
Cumulative amount of opioids consumed during surgery
Time frame: during surgery
Oral morphine equivalent consumption in PACU
Cumulative oral morphine equivalent consumed in PACU
Time frame: PACU admission to PACU discharge (approximately 4 hours)
Post-operative Pain
area under the curve for rest pain scores during the first 24 hours post-op, using the numeric pain rating scale from 0-10, with 0 being no pain and 10 being the worst possible pain
Time frame: Up to 24 hours post-operative
Quality of Recovery
Measured using the QoR-15 questionnaire at 24 hours post-op
Time frame: At 24 hours post-operative
Time in hospital
Time from admission to discharge
Time frame: From hospital admission to hospital discharge (approximately 12 hours)
Nerve Block Complications
Presence or absence of nerve block complications
Time frame: up to 24 hours post-operative, up to 2 weeks post-operative
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