Regional Anesthesia Utilizing Liposomal Bupivacaine, With or Without Dexamethasone, Provides Excellent Pain Control and Minimizes Opioid Consumption Following Anterior Cruciate Ligament Reconstruction.

Background: Perioperative nerve blocks are commonly used for regional analgesia with anterior cruciate ligament (ACL) reconstruction (ACLR). Liposomal bupivacaine (LB) is a long-acting anesthetic agent providing up to 72 hours of nerve blockade. It is theorized that the addition of dexamethasone to LB (LB+dex) may prolong the analgesic duration. Purpose: To characterize pain control and opioid consumption with adductor canal block (ACB), interspace between the popliteal artery and capsule of the posterior knee (iPACK), and suprasartorial infiltration (SSI) regional anesthetic techniques utilizing LB after ACLR and to compare LB versus LB+dex. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Patients undergoing primary ACLR using bone-patellar tendon-bone or quadriceps tendon autograft were included. All patients received an ACB, iPACK, and SSI preoperatively. Patients were randomized to receive either LB or LB+dex for their anesthetic agent. Opioid consumption, visual analog scale (VAS) scores, pain control satisfaction, and duration of block effect were recorded postoperatively. Results: A total of 131 patients were included in the analysis. The mean opioid consumption for all patients was 1.20 ± 2.42 five-mg oxycodone tablets (8.97 ± 18.12 morphine milliequivalents [MME]). We did not observe a significant difference in oxycodone consumption between cohorts during the study period (1.42 ± 2.92 vs 0.97 ± 1.91; 10.65 ± 21.90 MME vs 7.28 ± 14.33 MME; P = .76). An estimated 95.2% of opioids prescribed went unused and 77.1% (101/131) of patients consumed no opioids. There was no significant difference in VAS score, patient satisfaction, or duration of block effect between cohorts. Conclusion: A single shot of LB with or without dexamethasone via ACB, SSI, and iPACK block provided excellent pain control and minimized opioid consumption after autograft ACLR. Nearly 80% of patients did not require opioids postoperatively, making opioid-free ACLR a realistic possibility for many patients. When narcotics were required, the dose of opioids was minimal; patients required 1.2 tablets of oxycodone on average, and >95% of the opioids prescribed went unused. Despite previous reports suggesting a prolonged duration of anesthetic effect when LB is combined with dexamethasone, we found no difference in opioid consumption, VAS score, patient satisfaction, or duration of block effect when patients received dexamethasone with their regional block. The utilization of regional anesthetic techniques such as ACB, SSI, and iPACK blocks in conjunction with LB-based anesthetics could allow providers to curtail or potentially eliminate opioid prescriptions after ACL surgery. Registration: NCT06006624 (ClinicalTrials.gov identifier).