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Controlling Pain After Anterior Cruciate Ligament Repair

Patients who have anterior cruciate ligament repair have pain after the operation that can interfere with rehab and recovery. Different narcotics have been used to help control the pain right after surgery.

In this study pain control using a nerve block was compared to results with an injection into the knee joint. For the first 24 hours, group one had continuous ropivacaine femoral block. The drug is delivered directly to the nerve. Group two had a single injection of bupivacaine and morphine into the joint.

The researchers thought the nerve block group would have lower pain. They expected the block patients to be able to do their physical therapy program easier than the injection group.

It turns out there was no difference between the block and injection groups. Patients in both groups had the same amount of pain control with equal amounts of narcotics. Past studies have also shown that combining the two treatments together (block and injection) doesn't offer any extra pain relief.

The authors report the femoral block fails in some cases due to poor placement of the catheter through which the drug is infused. The needle is usually placed just under the nerve sheath (outer covering of the nerve). They advise surgeons to be prepared to manage pain some other way if this happens.

References: G. William Woods, MD, et al. Continuous Femoral Nerve Block Versus Intra-Articular Injection for Pain Control After Anterior Cruciate Ligament Reconstruction. In The American Journal of Sports Medicine. August 2006. Vol. 34. No. 8. Pp. 1328-1333.

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