Analgesic efficacy of regional and local analgesic techniques for anterior cruciate ligament reconstruction in adults undergoing general anesthesia: a systematic review and network meta-analysis
In brief
Femoral and sciatic nerve blocks were linked to 40 mg less opioid use
In a network meta-analysis of 31 trials and 2,470 adults, the combined blocks were associated with an estimated 40 mg less opioid use in the first 24 hours than control. But only six studies had low risk of bias, and the estimate became less certain when high-risk studies were excluded; no technique was shown to be clinically superior overall.
- Journal
- BMC anesthesiology (Q1)
- Published
- 29 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Liaoyuan Xu, Kefan Chen, Chun Yang, Peng Jiang
- PMID
- 42972238
- DOI
- 10.1186/s12871-026-04387-6
Why clinicians should know about it
- Picked for Anesthesiology and Pain Medicine (paper of the day, 5 November 2026): Network meta-analysis compares regional analgesic techniques after ACL reconstruction
Abstract
BACKGROUND: Acute pain after anterior cruciate ligament reconstruction (ACLR) can impair early mobility and rehabilitation. This network meta-analysis (NMA) compared regional and local analgesic techniques in adults undergoing ACLR under general anesthesia. METHODS: PubMed, Embase, the Cochrane Library, and Web of Science were searched from inception to February 18, 2026, for randomized controlled trials. Risk of bias was assessed utilizing the revised Cochrane risk-of-bias tool (RoB2), and a Bayesian random-effects NMA was performed. RESULTS: Thirty-one studies involving 2,470 patients were included. Only six were at low risk of bias. For oral morphine milligram equivalents (OMME) at 24 h postoperatively, femoral nerve block (FNB) [mean difference (MD) = - 30.31, 95% credible interval (CrI) - 58.02, - 6.79] and FNB with sciatic nerve block (SNB) [MD = - 40.42, 95% CrI - 80.42, - 5.79] were associated with lower estimated opioid consumption than control. FNB with SNB ranked highest for lower 24-h OMME [surface under the cumulative ranking curve (SUCRA) = 87.44%]. FNB with graft donor-site infiltration was associated with lower estimated pain scores in the post-anesthesia care unit (PACU) than local infiltration analgesia (MD = - 2.46, 95% CrI: -4.67, - 0.21). At 24 h, adductor canal block (ACB) with graft donor-site infiltration had lower estimated pain scores than ACB (MD = - 1.50, 95% CrI: -2.43, - 0.61). At 48 h, the 95% CrIs for all pain comparisons included 0. ACB with infiltration between the popliteal artery and capsule of the posterior knee (iPACK) had a longer estimated time to first analgesic request (TFAR) than ACB (MD = 7.50, 95% CrI: 1.92, 13.01). Regarding postoperative nausea and vomiting (PONV), the 95% CrIs for all comparisons included 1. In sensitivity analyses excluding high-risk studies, the CrIs for key comparisons regarding OMME and TFAR widened and included 0. Some treatment nodes were missing from certain outcome networks, and the rankings for PONV changed. CONCLUSION: Potential analgesic benefits varied across outcomes, but key estimates became less precise after high-risk studies were excluded. Functional outcomes were not systematically synthesized, and adverse event assessment was limited to PONV. These findings do not establish the overall clinical superiority of any single strategy. CLINICAL TRIAL NUMBER: Not applicable.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.