Postoperative analgesia after arthroscopic anterior cruciate ligament reconstruction: A comparison between intra-articular ropivacaine injection and adductor canal block, A prospective cohort study

Abstract

Background: Postoperative pain in arthroscopic acl reconstruction causing delay in rehabilitation protocol resulting in significant morbidity.opiod medications may have significant pain control but systemic adverse effects are of main concern. Delivering Ropivacaine either intraarticularly or by saphenous nerve block in adductor canal will reduce systemic adverse effects or are more effective in pain control.our study focuses on comparing effectiveness of adductor canal block versus intraarticular injection of ropivacaine in postoperative pain control. Materials and Methods: 60 patients undergoing arthroscopic acl reconstruction by same operating surgeon under spinal anaesthesia are divided into three groups. group A patients were given adductor canal block with 30 ml 0.2 % ropivaciane under ultrasound guidance postoperatively, group B patients were given intraarticular injection with 30 ml 0.2 % ropivaciane postoperatively, group c or control patients receiving routine analgesia. Visual Analogue Score (VAS), Amount of morphine consumption,post op knee range of movement achieved was recorded at intervals of 6, 12, 24, 48 hours after the procedure. Results: The intraatrticular group, adductor canal block had lower vas at 6,12,24 hours (p 0.05) compared to control group. The intraaticular group required 30mg less total morphine consumption compared to control group at 48 hours,required 10mg less total morphine consumption compared to adductor canal block at 48 hours.post op knee rom improved in both the groups compared to control group (p >0.05) but statistically not significant. Conclusion: Both Intraarticular ropivacaine injection & adductor canal block are equally efficacious in pain control during first 24 hours after arthroscopic acl reconstruction compared to control group. However intraarticular injection group requires less amount of morphine consumption than adductor canal block group Because intraarticular injection is easy and does not require technical expertise as in nerve blocks and also does not require special equipment like ultrasound, So we recommend intraarticular ropivacaine injection as an effective pain control solution for postoperative pain control in arthroscopic ACL reconstruction.