Pain relief after ACL reconstruction

Excerpt

Good pain relief after an ACL reconstruction is not only important for minimizing postoperative pain, but is equally important for rehabilitation. As our group in Stockholm showed some 25 years ago, it is the postoperative pain that inhibits normal muscle activity immediately after surgery and is largely responsible for the muscle hypotrophy. We used continuous epidural analgesia through an inlaying catheter for 2–3 days and were able to even increase the oxidative activity of the quadriceps muscle during the 1st week after surgery. Kehlet in Denmark has also shown that using epidural anaesthesia blocks the information from the operated knee to the adrenal glands, thus blocking the postoperative release of corticosteroids from the adrenals. This also contributes to better rehabilitation, since it minimizes the catabolism usually seen after surgery. Postoperative pain treatment is thus extremely important. At my recent advanced course of arthroscopy in Courmayeur, Italy, Hayden Morris from Melbourne, Australia added a new measure to improve the postoperative pain treatment. He showed that using cold irrigation fluid during the arthroscopic procedure significantly reduced the postoperative pain. …