Effect of preemptive multimodal analgesia for arthroscopic knee ligament repair

Background and Objectives: Administration of analgesic medication before su rgery, rather than at the completion of the procedure, may reduce postopera tive pain. Similarly, administration of multiple analgesics, with different mechanisms of action, may provide improved postoperative pain control and functional recovery. The purpose of our study was to compare pain scores an d intravenous opioid consumption after outpatient anterior cruciate ligamen t (ACL) reconstruction in patients who received a multimodal drug combinati on (intravenous [IV] ketorolac, intra-articular morphine/ropivacaine/epinep hrine, and femoral nerve block with ropivacaine) either before surgery or i mmediately at the completion of the surgical procedure. Methods: Forty patients presenting for same-day arthroscopic ACL repair usi ng a semitendinosis tendon graft were included in this study. The patients were randomized to receive the following drugs either 15 minutes before ski n incision or immediately after skin closure: (1) Ketorolac 30 mg IV. (2) I ntra-articular injection of 20 mt ropivacaine 0.25% + morphine 2 mg and epi nephrine 1:200,000. (3) Femoral nerve block with 20 mt ropivacaine 0.25%. V erbal pain scores were obtained in the postanesthesia care unit (PACU) and on postoperative days 1, 3, and 7. TY patient controlled analgesia (PCA) mo rphine consumption in the PACU was also recorded. Results: Verbal pain rating scores were lower in group I (preemptive) for 2 .0 hours after arrival in the PACU. There was no difference between groups in pain scores on postoperative days 1, 3, and 7. Mean TV PCA morphine cons umption in the PACU was lower in group I (6.4 mg) versus group II (12.3 mg) , P < .05. Conclusion: Preemptive, multimodal administration of our 3-component analge sic drug combination resulted in lower pain scores during the initial stay in the PACU unit and lower consumption of IV PCA morphine in the PACU. Howe ver, pain scores were similar in both groups on postoperative days 1, 3, an d 7; thus, there was no measurable long-term advantage associated with pree mptive multimodal drug administration.