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Local instillation analgesia for ambulatory anterior cruciate ligament reconstruction: A systematic review and meta-analysis of randomized controlled trials
Session: MP-05a
Fri, Nov. 17, 8:00-10:00 am
Hampton Room

Please note, medically challenging cases are removed three months after the meeting and scientific abstracts after three years.

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Local Instillation Analgesia for Anterior Cruciate Ligament Reconstruction

 

Eric M. Yung, BHSc, MD (Cand.)1, Richard Brull, MD, FRCPC1,2, Faraj W. Abdallah, BSc, MD1,3,4

 

1 Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada; 2 Department of Anesthesia, Women’s College Hospital, Toronto, Ontario, Canada; 3 Department of Anesthesia and the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada; 4 Department of Anesthesiology and Pain Medicine, and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada

•Effective postoperative analgesia following orthopedic anterior cruciate ligament reconstruction (ACLR) is essential for optimal patient recovery, satisfaction, functional outcomes, and timely discharge1
•Currently used modalities include peripheral nerve blocks, oral/parenteral analgesia, and local instillation analgesia (LIA) of the knee joint; however, consensus around the optimal approach is lacking2
•The aim of this systematic review and meta-analysis was to determine the efficacy of LIA in the setting of ambulatory patients undergoing ACLR
•We sought randomized controlled trials of adults undergoing ACLR comparing LIA to Control (no intervention, placebo, or oral or intravenous analgesics)
•The primary outcome was cumulative postoperative analgesic consumption at 24h
•Secondary outcomes included:
ØCumulative analgesic consumption during PACU stay
ØPain scores at rest during first 48h postoperatively
ØIncidence of postoperative opioid-related side effects
•11 studies (515 patients) met the inclusion criteria; these included 320 in the LIA groups and 195 in the control groups
•LIA administration significantly reduced postoperative cumulative analgesic consumption and pain scores in the first 24h postoperatively compared to Control
•Our findings demonstrate the analgesic utility of LIA in patients undergoing ambulatory ACLR
•Compared to Control, LIA significantly reduced postoperative analgesic consumption, and pain scores up to 24h postoperatively
•Congruent with positive findings of a previous systematic review2, this is the first high-level synthesis supporting the benefits of LIA in ACLR
•LIA techniques have shown significant benefit in similar settings such as knee arthroscopy3 and arthroplasty4
•Limitations: Small study sample size, inconsistent outcome reporting in included studies, and significant heterogeneity in pooled results
1.There is good evidence to support the integration of LIA into clinical practice for patients undergoing ambulatory ACLR
2.Further work will need to delineate an ideal LIA regimen with regards to constituents, dose, locations of injections, and relevance to peripheral nerve blocks.
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