Regional Anesthesia for ACL Surgery

The anterior cruciate ligament (ACL) is one of the major ligaments in the knee joint. Injuries to the ACL are common, particularly among athletes involved in sports that require sudden stops, changes in direction, or jumping. ACL tears can range from partial to complete, and they often require surgical intervention, such as ACL reconstruction, followed by rehabilitation to restore knee function and stability (1). Traditionally, general anesthesia, which renders the patient completely unconscious, has been the standard for ACL surgery. However, the advent of regional anesthesia has provided an additional approach that can offer significant benefits for ACL surgery, including reduced postoperative pain, faster recovery, and fewer side effects (1).

Regional anesthesia works by numbing a specific part of the body, thereby blocking pain in the target area. The most commonly used regional techniques for ACL surgery are spinal, epidural, and peripheral nerve blocks. In spinal and epidural anesthesia, the entire lower part of the body is numbed by injecting an anesthetic near the spinal cord. Peripheral nerve blocks, such as the femoral nerve block or the newer adductor canal block, specifically target the nerves that supply the knee (2). Several studies have highlighted the superiority of regional anesthesia over general anesthesia for ACL surgery. For instance, Liu et al. (2023) conducted a network meta-analysis to assess different regional anesthetic techniques (2). The study concluded that although no single nerve block was significantly superior, regional anesthesia consistently resulted in better pain management outcomes and reduced opioid consumption post-operation when compared to general anesthesia. Furthermore, Zhu et al. (2020) found that adding ketamine to ropivacaine for nerve block significantly improved analgesia and facilitated early mobilization on the first postoperative day, supporting quicker recovery for ACL reconstruction patients (3). These studies collectively highlight the advantages of regional anesthesia in improving postoperative outcomes in ACL surgery.

The benefits of regional anesthesia extend beyond immediate postoperative outcomes. The reduced reliance on opioids associated with the adoption of regional anesthetic techniques is consistent with current medical guidelines aimed at combating the opioid epidemic. In addition, the faster functional recovery afforded by effective pain control means that patients can begin physical therapy sooner, potentially leading to better long-term outcomes in ACL rehabilitation (3).

However, the choice of anesthesia for surgery is influenced by several factors, including patient preference, potential allergies, and specific health conditions. For example, patients with coagulation disorders or pre-existing neurological deficits may not be ideal candidates for certain types of regional blocks. Moreover, the successful administration of regional anesthesia is highly dependent on the expertise of the anesthesiologist. This technique requires a deep understanding of human anatomy and the ability to use advanced imaging technologies, such as ultrasound or nerve stimulation, to accurately place the nerve block. The anesthesiologist’s skill not only ensures effective pain management, but also minimizes the risk of complications during and after the procedure (1).

Regional anesthesia is a viable and often preferable alternative to general anesthesia for patients undergoing ACL surgery. Its ability to provide effective pain management, reduce opioid dependence, and facilitate faster recovery makes it an attractive choice in the modern surgical setting.

References

1. Baverel L, Cucurulo T, Lutz C, Cournapeau J, et al. Anesthesia and analgesia methods for outpatient anterior cruciate ligament reconstruction. Arthroscopy and Traumatology: Surgery & Related Research. 2016;32(3):187-195.
2. Liu H, Song X, Li C, Li Y, Guo W, Zhang H. Efficacy of regional anesthesia interventions within 24 hours following anterior cruciate ligament reconstruction: A network meta-analysis. Arthroscopy and Related Surgery. 2023;39(2):500-512.
3. Zhu T, Gao Y, Xu X, Fu S, Lin W, Sun J. Ketamine added to ropivacaine in nerve block for postoperative pain management in patients undergoing anterior cruciate ligament reconstruction: a randomized trial. Clinical Therapeutics. 2020;42(5):950-961.