Comparison of spinal and general anesthesia in combination with adductor canal block and local infiltration anesthesia in arthroscopic cruciate ligament surgery: a randomized controlled trial

Objective. To compare the effectiveness of spinal anesthesia with combined general anesthesia, including adductor canal block and local infiltration anesthesia, in arthroscopic cruciate ligament surgery. Material and methods. Study design: a single-center, randomized controlled trial performed under conditions of single blindness. 107 patients who underwent arthroscopic cruciate ligament surgery (ACL) using the envelope method were divided into two groups according to the option of the intended anesthetic provision: group 1 — spinal anesthesia (SA) — 54 patients; group 2 — general anesthesia (GA): adductor canal block (ACB) + local infiltration anesthesia (LIA) — 53 patients. Outcome: the primary endpoint of the study was the dynamics of the intensity of postoperative pain, estimated on a 10-centimeter visual analogue scale (VAS) at rest and during movement of the operated limb immediately after surgery and every 4 hours for 1 day. The secondary points of the study were: the time before the first request for anesthesia; the time of verticalization; the need to prescribe opioid analgesics to patients and their total dose on the first day after surgery; the presence of criteria for rebound pain; patient satisfaction with anesthesia; patient satisfaction with postoperative pain relief. Results. More intense pain syndrome in patients at all stages of the study was noted when moving the operated limb in group 1 (CA) — 3.50±0.81 points compared with 1.82±0.92 points in patients in group 2 (OA) (p<0.001). In the SA group, 43 patients (82.7%) needed opioid analgesics in the postoperative period, and 8 of them (18%) required their administration 2 or more times a day. In the GA+ACB+LIA group only 11 patients (22%) needed a single opioid prescription. Among those who received trimeperidine, the total daily dose did not differ between the groups and averaged 40 mg (p=0.130). The time to the first analgesic request was significantly longer in group 2: the median was 380 [300; 480] minutes versus 180 [140; 200] minutes in group 1 (p<0.001). The time of verticalization in the first and second groups was 230 [197.5; 260.0] minutes and 130 [116.25; 158.75] minutes, respectively (p<0.001). The criteria for rebound pain were noted in 80.8% of patients in group 1 and 8% in group 2. Conclusion. The technique of combined anesthesia, which includes not only the blockage of the peripheral nerves of the lower limb, but also the local effect of local anesthetic on the sensory branches of nerves through infiltration anesthesia, can be effectively used in arthroscopic plastic surgery of cruciate ligaments. Further research is needed on the prevention of the phenomenon of rebound pain.