Pain Management for Ambulatory Arthroscopic Anterior Cruciate Ligament Reconstruction: Evidence-Based Recommendations From the Society for Ambulatory Anesthesia

被引:34
作者
Abdallah, Faraj W. [1 ,2 ]
Brull, Richard [3 ]
Joshi, Girish P. [4 ]
机构
[1] Univ Ottawa, Ottawa Hosp Res Inst, Dept Anesthesiol & Pain Med, Ottawa, ON, Canada
[2] Univ Toronto, Li Ka Shing Knowledge Inst, Dept Anesthesia, Toronto, ON, Canada
[3] Univ Toronto, Womens Coll Hosp, Dept Anesthesia, Toronto, ON, Canada
[4] Univ Texas Southwestern Med Ctr Dallas, Dept Anesthesiol & Pain Management, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
关键词
FEMORAL NERVE BLOCK; ADDUCTOR CANAL BLOCKADE; POSTOPERATIVE ANALGESIA; KNEE SURGERY; BUPIVACAINE; MORPHINE; ROPIVACAINE; GUIDELINES; KETOROLAC; INJECTION;
D O I
10.1213/ANE.0000000000003976
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Ambulatory arthroscopic anterior cruciate ligament reconstruction is associated with moderate pain, even when nonopioid oral analgesics such as acetaminophen and nonsteroidal anti-inflammatory drugs are used. Regional analgesia can supplement nonopioid oral analgesics and reduce postoperative opioid requirements, but the choice of regional analgesia technique for anterior cruciate ligament reconstruction remains controversial. Femoral nerve block, adductor canal block, and local instillation analgesia have all been proposed and are supported by some evidence from randomized controlled trials. Consequently, regional analgesia practice in patients undergoing anterior cruciate ligament reconstruction remains mixed. Published systematic reviews were used to identify the regional analgesia modality that would provide a balance between analgesic efficacy and associated potential risks in the setting of nonopioid multimodal analgesic strategies. Based on the evidence available, local instillation analgesia provides the best balance of analgesic efficacy and associated risks (strong recommendation, moderate level of evidence) when used as a component of multimodal analgesic technique in the first 24 hours after outpatient arthroscopic anterior cruciate ligament reconstruction. In the absence of local instillation analgesia, clinicians might use adductor canal block or femoral nerve block (weak recommendation, weak level of evidence). These recommendations have been endorsed by the Society of Ambulatory Anesthesia and approved by its board of directors.
引用
收藏
页码:631 / 640
页数:10
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