A comparison of pain scores and medication use in patients undergoing single-bundle or double-bundle anterior cruciate ligament reconstruction

• Published in: Canadian Journal of Surgery Vol. 57; no. 3; pp. E98 - E104
• Main Authors: Macdonald, Simon A., BHSc, Heard, S. Mark, MD, Hiemstra, Laurie A., MD, PhD, Buchko, Gregory M.L., MD, Kerslake, Sarah, BPhty, Sasyniuk, Treny M., MSc
• Format: Journal Article
• Language: English
• Published: Canada Joule Inc 01.06.2014; CMA Impact, Inc; Canadian Medical Association
• Subjects: Acetaminophen - therapeutic use; Acute pain; Adult; Analgesics, Non-Narcotic - therapeutic use; Analgesics, Opioid - therapeutic use; Analysis; Anesthesia; Anterior Cruciate Ligament - surgery; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction - methods; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Care and treatment; Drugs; Female; Humans; Knee Injuries - surgery; Male; Online Research; Pain management; Pain Measurement; Pain, Postoperative - diagnosis; Pain, Postoperative - drug therapy; Pain, Postoperative - etiology; Patient outcomes; Postoperative Care - methods; Postoperative Care - standards; Quality Assurance, Health Care; Quality of life; Self Report; Skin & tissue grafts; Studies; Surgery; Treatment Outcome; Canada
• ISSN: 0008-428X; 1488-2310
• DOI: 10.1503/cjs.018612

Background No gold standard exists for the management of postoperative pain following anterior cruciate ligament reconstruction (ACLR). We compared the pain scores and medication use of patients undergoing single-bundle (SB) or double-bundle (DB) ACLR in the acute postoperative period. Pain and medication use was also analyzed for spinal versus general anesthesia approaches within both surgery types. Methods We assessed 2 separate cohorts of primary ACLR patients, SB and DB, for 14 days postoperatively. We used a standard logbook to record self-reported pain scores and medication use. Pain was assessed using a 100 mm visual analogue scale (VAS). Medications were divided into 3 categories: oral opioids, oral nonsteroidal anti-inflammatories and acetaminophen. Results A total of 88 patients undergoing SB and 41 undergoing DB ACLR were included in the study. We found no significant difference in VAS pain scores between the cohorts. Despite similar VAS pain scores, the DB cohort consumed significantly more opioid and analgesia medication ( p = 0.011). Patients who underwent DB with spinal anesthesia experienced significantly less pain over the initial 14-day postoperative period than those who received general anesthesia ( p < 0.001). Conclusion Adequate pain relief was provided to all ACLR patients in the initial postoperative period. Patients in the DB cohort experienced more pain, as evidenced by the significant difference in consumption of opioids and acetaminophen, than the SB cohort. Patients who underwent spinal anesthesia experienced less pain in the acute postoperative period than those who received general anesthesia.