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Pain Management for Ambulatory Arthroscopic Anterior Cruciate Ligament Reconstruction: Evidence-Based Recommendations From the Society for Ambulatory Anesthesia
- Source :
- Anesthesia and analgesia. 128(4)
- Publication Year :
- 2019
-
Abstract
- 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.
- Subjects :
- Risk
Anterior cruciate ligament reconstruction
Adductor canal
medicine.medical_treatment
03 medical and health sciences
Arthroscopy
0302 clinical medicine
Femoral nerve
Meta-Analysis as Topic
030202 anesthesiology
Anesthesia, Conduction
Ambulatory Care
Medicine
Humans
Pain Management
Anesthesia
Societies, Medical
Acetaminophen
Analgesics
Pain, Postoperative
Evidence-Based Medicine
medicine.diagnostic_test
Anterior Cruciate Ligament Reconstruction
business.industry
Anti-Inflammatory Agents, Non-Steroidal
Nerve Block
Evidence-based medicine
Ambulatory Surgical Procedure
Anesthesiology and Pain Medicine
medicine.anatomical_structure
Ambulatory Surgical Procedures
Ambulatory
Practice Guidelines as Topic
Nerve block
business
030217 neurology & neurosurgery
Femoral Nerve
Systematic Reviews as Topic
Subjects
Details
- ISSN :
- 15267598
- Volume :
- 128
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Anesthesia and analgesia
- Accession number :
- edsair.doi.dedup.....f7381230634dd6d1c5b38f4334d45715