Reduced Opioid Use After Surgeon-Administered Genicular Nerve Block for Anterior Cruciate Ligament Reconstruction in Adults and Adolescents
- 5 Downloads
Pain management after anterior cruciate ligament reconstruction (ACLR) may pose a risk of prolonged opioid use.
The purposes of this study in ACLR were to investigate the efficacy of a surgeon-administered local–regional block of specific genicular nerves on post-operative analgesia following ACLR and to quantify the outpatient opioid consumption and duration through the complete post-operative course.
Prospectively, all patients undergoing primary ACLR by a single surgeon were studied over a 10-month period. Exclusion criteria consisted of history of pre-operative opioid use, revision surgery, multi-ligament surgery, allergy to oral opioids, and allergy to local anesthetic. ACLR was performed using autograft or allograft patellar tendon bone (PTB) graft under general anesthesia. At the conclusion of the procedure, all patients received a local anesthetic (bupivacaine 0.25%) injection by the surgeon including a unique circumferential genicular nerve and fat pad block performed based on anatomic landmarks without use of image guidance. Post-operatively, the quantity and duration of opioid use (hydrocodone 5 mg) and pain scores were recorded for 4 months prospectively. Statistical analysis was performed to evaluate risk factors for increased opioid use.
A single surgeon performed 75 ACLRs. After exclusions, a total of 70 patients were enrolled and followed prospectively. None were lost to follow-up. Total opioid consumption ranged from 0 to 30 tablets. The average number of opioid tablets used over the 4-month post-operative course was 5.5 (± 6.7). After surgery, 84% of patients took between 0 and 10 tablets and 21% of patients took no opioids throughout their entire post-operative course. The average duration of consumption was 2.6 days (± 3.1). No patients were taking opioids at the 6-week or 4-month follow-up. There were no refills required. No statistically significant differences were seen in regard to graft choice of autograft PTB (n = 48) vs allograft PTB (n = 22) in total opioid consumption or duration of use. In comparing adolescent (n = 31) versus adult (n = 39), no significant difference was seen in total opioid consumption or duration of use. All patients were satisfied with the post-operative pain management protocol.
Opioid use was unexpectedly low among patients undergoing ACLR after a surgeon-administered circumferential genicular nerve block and fat pad infiltration. With this protocol, the graft choice and patient age did not correlate with increased opioid use. These results could be useful in guiding post-operative opioid prescribing after ACLR.
Keywordsanterior cruciate ligament reconstruction ACL opioid adolescent genicular nerves
We thank Patrick Hardigan PhD, MBA, and Natan Gold, Nova Southeastern University, Fort Lauderdale, FL, for statistical assistance.
Compliance with Ethical Standards
Conflict of Interest
George L. Caldwell, Jr., MD, and Michael A. Selepec, PA-C, declare that they have no conflict of interest.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2013.
Informed consent was waived from all patients for being included in this study.
Required Author Forms
Disclosure forms provided by the authors are available with the online version of this article.
- 15.Horner G, Dellon AL. Innervation of the human knee joint and implications for surgery. Clin Orthop Relat Res. 1994(301):221–226.Google Scholar
- 16.Howell R, Hill B, Hoffman C, Treacy E, Mulcahey MK. Peripheral nerve blocks for surgery about the knee. JBJS Rev. 2016;4(12).Google Scholar
- 26.Matava MJ, Prickett WD, Khodamoradi S, Abe S, Garbutt J. Femoral nerve blockade as a preemptive anesthetic in patients undergoing anterior cruciate ligament reconstruction: a prospective, randomized, double-blinded, placebo-controlled study. Am J Sports Med. 2009;37(1):78–86.CrossRefPubMedGoogle Scholar
- 31.US Food and Drug Administration. Safe disposal of medicines: flushing of certain medicines. Silver Spring, MD. 2018. Available from https://www.fda.gov/drugs/resourcesforyou/consumers/buyingusingmedicinesafely/ensuringsafeuseofmedicine/safedisposalofmedicines/ucm186187.htm