A systematic review of pain management options after outpatient ACL reconstruction

Study Type: Systematic review
OE Level of Evidence: 2
Journal Level of Evidence: N/A
77 randomized controlled trials were identified for inclusion in this systematic review evaluating modalities for pain management following arthroscopic ACL reconstruction in an outpatient setting. Evidence evaluating regional nerve blocks, intra-articular (IA) injections, intravenous (IV) and intramuscular (IM) injections, multimodal analgesia, oral medications, cryotherapy compression, mobilization strategies, and intraoperative techniques for the management of pain was identified. The results of Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Non-funded
Conflicts: None disclosed
Why was this study needed now?
Inadequate pain management following ACL reconstruction can negatively affect postoperative recovery and satisfaction of patients. While there are a number of different modalities that can be employed to reduce postoperative pain, an ideal method has yet to be identified from the literature. This systematic was conducted to provide a comprehensive synthesis of high-quality evidence evaluating methods of pain management following arthroscopic ACL reconstruction.
What was the principal research question?
What is the current state of high-quality literature evaluating the different methods of pain management for outpatient arthroscopic ACL reconstruction?
Data Source: Electronic databases PubMed, Medline, Google Scholar, UpToDate, Chochrane Reviews, CINAHL, and Scopus were searched from inception to July 2014. Additional hand searches of the reference sections of included articles were also conducted.
Index Terms: Searches were conducted using a combination of the following terms "anterior cruciate ligament", "postoperative pain", "multimodal analgesia", "immobilization", "early weightbearing", "cryotherapy", "compression", "intra-articular (IA) injections", "nerve blocks", "nonsteroidal anti-inflammatory drugs (NSAIDs)", "hydrocodone", "acetaminophen", and "opiates".
Study Selection: Trials were included if they met the following criteria: 1) were randomized controlled trials; 2) compared any 2 or more pain management modalities or placebo; 3) used objective measures to quantify postoperative pain within 1 month of surgery; and 4) applicability in outpatient ACL reconstruction. Any type of arthroscopic reconstruction was included, as well as studies that performed co-procedures (meniscus or articular cartilage procedures). The methods detailing the selection process were not provided in the manuscript.
Data Extraction: The methods detailing the extraction of data were not provided in the manuscript. Postoperative pain and rescue medication consumption were the primary outcomes of interest.
Data Synthesis: Data was not pooled via meta-analysis and was reported in a qualitative manner.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.