Network meta‐analysis of the analgesic effectiveness of regional anaesthesia techniques for anterior cruciate ligament reconstruction

作者：Nasir Hussain, Richard Brull, Christopher Vannabouathong, Jarod Speer, Christopher M. Lagnese, Colin J. L. McCartney, Faraj W. Abdallah · 发表于：Anaesthesia · 年份：2022 · DOI：10.1111/anae.15873 · 被引用次数：22 · 研究领域：Knee injuries and reconstruction techniques、Anesthesia and Pain Management、Total Knee Arthroplasty Outcomes

Anterior cruciate ligament reconstruction can cause moderate to severe acute postoperative pain. Despite advances in our understanding of knee innervation, consensus regarding the most effective regional anaesthesia techniques for this surgical population is lacking. This network meta-analysis compared effectiveness of regional anaesthesia techniques used to provide analgesia for anterior cruciate ligament reconstruction. Randomised trials examining regional anaesthesia techniques for analgesia following anterior cruciate ligament reconstruction were sought. The primary outcome was opioid consumption during the first 24 h postoperatively. Secondary outcomes were: rest pain at 0, 6, 12 and 24 h; area under the curve of pain over 24 h; and opioid-related adverse effects and functional recovery. Network meta-analysis was conducted using a frequentist approach. A total of 57 trials (4069 patients) investigating femoral nerve block, sciatic nerve block, adductor canal block, local anaesthetic infiltration, graft-donor site infiltration and systemic analgesia alone (control) were included. For opioid consumption, all regional anaesthesia techniques were superior to systemic analgesia alone, but differences between regional techniques were not significant. Single-injection femoral nerve block combined with sciatic nerve block had the highest p value probability for reducing postoperative opioid consumption and area under the curve for pain severity over 24 h (78% and 90%, respective...