Pain Control for Anterior Cruciate Ligament Reconstruction Patients With Adductor Canal or Femoral Perineural Infusions

Nerve blocks are used to provide pain control after moderately painful orthopedic surgeries.
Anterior Cruciate Ligament (ACL) reconstruction with patellar autograft is a painful
orthopedic procedure performed after traumatic injury to the knee. Many patients undergoing
ACL reconstruction receive a nerve block as part of their anesthetic care. These blocks can
be performed in different locations along the femoral nerve, with advantages and
disadvantages to each location. Recently published evidence indicates that there is no
short-term difference in pain control between the two commonly-targeted locations ("Adductor
Canal" and "Femoral"). However, studies involving patients undergoing total knee arthroplasty
indicate that femoral blocks provide better pain control with movement than adductor canal
blocks. As many patients undergoing ACL reconstruction use continuous passive motion (CPM)
machines as part of rehabilitation starting on post-operative day one, the investigators
hypothesize that pain control and quality of recovery in the first 48 hours after surgery
will be superior with a continuous femoral block than with a continuous adductor canal block.
The investigators plan to study this by randomizing patients presenting for ACL
reconstruction to receive either a continuous femoral or continuous adductor canal block
(both considered adequate means of pain control), and following them to 48 hours to determine
the level of pain, quality of recovery score, opioid use, and CPM compliance.