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ANALGESIA

General Health and Knee Function Outcomes from 7 Days to 12 Weeks After Spinal Anesthesia and Multimodal Analgesia for Anterior Cruciate Ligament Reconstruction

Brian A. Williams, MD, MBA^*, Qainyu Dang, PhD, James E. Bost, PhD, James J. Irrgang, PhD, PT, ATC, Steven L. Orebaugh, MD^*, Matthew T. Bottegal, BS, and Michael L. Kentor, MD^*

From the *Department of Anesthesiology, School of Medicine, Department of Internal Medicine, School of Medicine, Center for Research on Health Care—Data Center, and Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.

Address correspondence to Brian A. Williams, MD, MBA, Department of Anesthesiology, UPMC South Side, Suite 2302, 2000 Mary St., Pittsburgh, PA 15203. Address e-mail to williamsba{at}anes.upmc.edu.

Abstract

BACKGROUND: We previously reported that continuous perineural femoral analgesia reduces pain with movement during the first 2 days after anterior cruciate ligament reconstruction (ACLR, n = 270), when compared with multimodal analgesia and placebo perineural femoral infusion. We now report the prospectively collected general health and knee function outcomes in the 7 days to 12 wk after surgery in these same patients.

METHODS: At three points during 12 wk after ACLR surgery, patients completed the SF-36 General Health Survey, and the Knee Outcome Survey (KOS). Generalized Estimating Equations were implemented to evaluate the association between patient-reported survey outcomes and (1) preoperative baseline survey scores, (2) time after surgery, and (3) three nerve block treatment groups.

RESULTS: Two hundred seventeen patients’ data were complete for analysis. In univariate and multiple regression Generalized Estimating Equations models, nerve block treatment group was not associated with SF-36 and KOS scores after surgery (all with P 0.05). The models showed that the physical component summary of the SF-36 (P < 0.0001) and the KOS total score (P < 0.0001) increased (improved) over time after surgery and were also influenced by baseline scores.

CONCLUSIONS: After spinal anesthesia and multimodal analgesia for ACLR, the nerve block treatment group did not predict SF-36 or knee function outcomes from 7 days to 12 wk after surgery. Further research is needed to determine whether these conclusions also apply to a nonstandardized anesthetic, or one that includes general anesthesia and/or high-dose opioid analgesia.