Opioid Use and Pain Decrease Between Days 3 and 7 After Quadriceps Tendon Anterior Cruciate Ligament Reconstruction in Adolescents

Abstract

Purpose

To detail pain levels and opioid consumption in the week following quadriceps tendon autograft (QT) anterior cruciate ligament (ACL) reconstruction among adolescents.

Methods

Adolescents (<19 years) undergoing ACL reconstruction with QT using an all-inside technique were enrolled at the time of surgery. All underwent general anesthesia with femoral and sciatic nerve blocks. A subset had an indwelling femoral nerve catheter until postoperative day (POD) 2. Numeric Rating Scale pain level (scale 0-10) and opioid use at defined intervals (4 PM to 12 AM the evening of surgery, 12 AM to 8 AM on POD1, 8 AM to 4 PM on POD1, POD3, and POD7) were recorded via surveys. Patients who did not return at least half of their pain surveys were excluded, and all had a minimum of POD3 follow-up. Pain levels were summarized, and pairwise comparisons between the subgroups with and without femoral nerve catheters were done. Univariate tests were performed to evaluate the association between recorded variables and outcomes of POD3 opioid use or POD3 pain ≥5.

Results

Fifty-eight patients were included. A median of 15 tablets of 5 mg of oxycodone were prescribed. On POD3, 26.8% of patients reported pain ≥5, and 26.8% reported opioid use. On POD7, 5.5% of patients reported pain ≥5, and 3.6% reported opioid use. In total, 35.2% never reported opioid use. Patients with indwelling femoral nerve catheters had lower opioid consumption during the 12 AM to 8 AM timeframe the night after surgery (0% vs 37.8%, P = .006), despite similar pain scores in this time frame (median 3/10 vs 4/10, P = .153). Only 1 opioid refill was required.

Conclusions

In adolescents, moderate pain may persist for 3 days after ACL reconstruction with QT, even with regional blocks. However, both substantial pain and opioid use are uncommon at POD7.

Level of Evidence

Level IV, retrospective therapeutic case series.