Pain Outcomes After Anterior Cruciate Ligament Reconstruction With Posterior Capsular Marcaine Injection
Status:
Terminated
Trial end date:
2017-05-10
Target enrollment:
Participant gender:
Summary
Post-operative pain control following elective anterior cruciate ligament reconstruction
continues to be a hurdle for orthopaedic surgeons. This obstacle becomes particularly
problematic during the first 36 hours after the operation, when the patient is experiencing
pain at its peak intensity. Good control of pain leads to better patient comfort, confidence
to place weight on the operative limb and improved ability to perform critical exercises in
this period to improve joint range of motion.
A variety of anesthetic techniques have been employed to reduce pain including: cryotherapy,
systemic analgesic and anti-inflammatory drugs, intrathecal, regional blockade of peripheral
nerves and frequently intra-articular injections. Each technique has been studied at length
with mixed but overall favorable results. However, in the authors' experience, after femoral
nerve blockade, patients continue to complain of posterior knee pain in the Post-Anesthesia
Care Unit (PACU) and peri-operative period. Intra-articular injections comprised of morphine
and other Na-channel blocker analgesics may curb some of this pain by bathing the posterior
capsule in anesthetic. However, there is still a large concern amongst orthopaedic surgeons
about the potential harm these agents may have on the knee's healthy articular cartilage
surfaces. The long term effects, including chondrolysis have been documented in the shoulder
and while in the short term this effect is diminished there is still hesitation among
surgeons to use this form of pain blockade.
This has led the investigators to adapt a technique of isolated posterior capsular injections
after total knee replacements from the joint arthroplasty literature, which has shown
favorable results with low complication risk. The investigators plan to study the
effectiveness of this technique during ACL reconstruction in an attempt to curb the amount of
posterior knee pain and decrease the overall narcotic use postoperatively while limiting the
exposure of the native cartilage to harmful agents.