Pain management by periarticular multimodal drug injection after anterior cruciate ligament reconstruction: A randomized, controlled study

Purpose: We aimed to determine the efficacy of periarticular (PA) multimodal drug cocktail (MDC) infiltration for pain control after anterior cruciate ligament reconstruction with an autogenous bone-patellar tendon-bone graft. Methods: We randomly assigned 100 patients to five study groups (20 per group): control group, no injection; intra-articular (IA) ropivacaine group, IA injection of ropivacaine alone; IA MDC group, IA injection of MDC; PA MDC group, PA injection of MDC; and IA + PA MDC group, IA and PA injections of MDC. The MDC consisted of ropivacaine, morphine, ketorolac, epinephrine, and cefuroxime. The five groups were compared in terms of pain levels during the first night after surgery and on postoperative days 1, 2, and 14; patient satisfaction was assessed on postoperative day 14. Results: The PA MDC and IA + PA MDC groups had less pain during the first night than patients in the other three groups (P <.001) and were more likely to have the same amount of pain or less pain on postoperative day 1 than their preoperative expectation (P =.05). However, there were no group differences in patient satisfaction on postoperative day 14. No MDC-related side effect was reported. Conclusions: The MDC injection, particularly when delivered periarticularly, provides an effective, safe means of reducing early postoperative pain after anterior cruciate ligament reconstruction at minimal cost. In addition, a single IA injection would have no value in pain relief, regardless of types of drugs. Level of Evidence: Level I, randomized controlled trial.