Pre-emptive analgesia in anterior cruciate ligament reconstruction

As more orthopedic surgical procedures are performed on an outpatient basis, mechanisms for postoperative pain control have become more important. Preemptive analgesia is the use of analgesics or anesthetic agents before painful stimuli occur to prevent or reduce subsequent pain. Two randomized prospective studies assessing the effect of pre-emptive analgesia in arthroscopically guided reconstruction using patellar tendon autograft were reviewed. Pre-emptive analgesia using intra-articular bupivacaine with epinephrine and morphine results in lower VAS pain scores during the first hour after arthroscopically guided, reconstructive anterior cruciate ligament surgery, compared to pre-emptive treatment with bupivacaine and epinephrine or placebo and epinephrine. Increased doses of intra-articular morphine before surgery did not improve postoperative pain control. These studies demonstrated a short duration of effect of pre-emptive analgesia and it is possible that a combination of pre-emptive analgesia, nonsteroidal anti-inflammatory drug therapy, and postoperative injection could be optimized to provide an effective, long-lasting treatment for postoperative pain.