Analgesic efficacy of a single-dose, intraoperative, intra-articular morphine application in ACL reconstruction

Network meta‐analysis of the analgesic effectiveness of regional anaesthesia techniques for anterior cruciate ligament reconstruction

“…A total of 25 studies (1749 patients) [69, 70, 77–83, 85, 90–94, 96, 101, 111, 115, 116, 118, 120–123] reported postoperative opioid related complications. Across the included studies, there were a total of 27 pairwise comparisons and eight regional anaesthetic techniques investigated: single‐injection FNB; single‐injection ACB; single‐injection LIA; single‐injection FNB combined with single‐injection SNB; single‐injection FNB combined with single‐injection LIA; continuous FNB; continuous FNB combined with single‐injection LIA; and control (systemic analgesia) (online Supporting Information, Appendix S17).…”

“…Of these, 34 were excluded due to their lack of randomised nature or being a crossover design (n = 2) [35, 36]; having an ineligible surgery or not having data for the ACL subgroup (n = 5) [37–41]; not having an active comparator group (n = 2) [42, 43]; or being the only study identified evaluating the specific comparison (n = 25) [44–68]. Subsequently, a total of 61 [69–129] full text randomised trials were considered for inclusion; however, after additional review, four [125–128] were excluded due to evaluating a technique that was not attached to any of the other nodes in the network. Thus, a total of 57 [69–124, 129] full‐text randomised trials were included in the systematic review and network meta‐analysis.…”

“…Subsequently, a total of 61 [69–129] full text randomised trials were considered for inclusion; however, after additional review, four [125–128] were excluded due to evaluating a technique that was not attached to any of the other nodes in the network. Thus, a total of 57 [69–124, 129] full‐text randomised trials were included in the systematic review and network meta‐analysis. The flow diagram for study inclusion is depicted in Fig.…”

“…Across the 57 included trials [69–124, 129], there were a total of 4069 patients who were allocated randomly to receive one of 10 interventions: single‐injection FNB; single‐injection ACB; single‐injection LIA; single‐injection FNB combined with single‐injection SNB; single‐injection FNB combined with single‐injection graft‐donor site infiltration; single‐injection FNB combined with single‐injection LIA; continuous FNB; continuous FNB combined with single‐injection LIA; graft‐donor site infiltration; and systemic analgesia alone (control). Overall, a total of 12 unique direct comparisons were assessed, which are shown Table 1.…”

“…Overall, a total of 12 unique direct comparisons were assessed, which are shown Table 1. Across all studies, 50 used single‐injection techniques alone [69–77, 79, 80, 82–102, 104–113, 115, 117–122, 124], six utilised continuous catheter‐based techniques alone [78, 81, 103, 114, 116, 129] and one compared single‐injection against continuous catheter‐based techniques [123]. Notably, of the six studies [78, 81, 103, 114, 116, 129] that used continuous catheter‐based techniques, four [78, 103, 114, 123] initiated the block postoperatively in the PACU.…”