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

Abstract

A comparison of pain scores and medication use in patients undergoing single-bundle or doublebundle anterior cruciate ligament reconstructionBackground: 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.

Opioid Demand Before and After Anterior Cruciate Ligament Reconstruction

“…16,19 The detrimental effect of preoperative opioid use on postoperative opioid demand and outcomes has been demonstrated in multiple orthopaedic patient populations. 11,13,20 Patient-reported opioid medication use after ACLR over the first 2 postoperative weeks has previously been reported, 3,14 although no long-term data or risk factors for elevated postoperative opioid demand are currently available.…”

Resolution of Pain and Predictors of Postoperative Opioid use after Bridge-Enhanced Anterior Cruciate Ligament Repair and Anterior Cruciate Ligament Reconstruction

“…Another study by Taylor et al, 34 which looked specifically at opioid consumption after ACLR, found a median use of 20 pills of oxycodone, equating to 150mg MED. MacDonald et al 35 compared groups undergoing single-bundle versus double-bundle ACLR and found an average oral opioid use of 39 and 49 pills in each group, respectively. However, in the study of MacDonald et al, there was no distinction made between an oral Percocet, oral Tramacet, or oral Tylenol-Codeine pill, so assuming each patient took only Tylenol-Codeine (which contains the least MED at 3 mg MED per pill), the average use was 117.6 mg MED for single bundle and 147 mg MED for double bundle ACLR.…”

Immediate post-operative pain in anterior cruciate ligament reconstruction surgery with bone patellar tendon bone graft versus hamstring graft

“…The study concluded that there was no difference in pain scores in the two groups; however, opioid use/analgesic medication use was more in the double-bundle group. Further, the patients who underwent surgery under spinal anaesthesia experienced less pain in the post-operative period than those who received general anaesthesia, as evidenced by significant difference in the consumption of analgesics amongst the two groups [ 29 ]. We operated on all the patients in both groups under spinal anaesthesia to remove this bias and its effects on pain scores in the post-operative period.…”