Gender Differences in Pain and Function after Arthroscopic Anterior Cruciate Ligament Reconstruction.Taenzer et al. (page 670)
To assess whether gender plays a role in report of pain and function after arthroscopic anterior cruciate ligament reconstruction (AACLR), Taenzer et al. performed a retrospective review of records from all patients undergoing AACLR at an outpatient facility since June of 1992. As part of a quality improvement program, patients had been asked to fill out questionnaires recording their pain scores, postoperative narcotic consumption and whether they could perform a straight leg raising maneuver on each of the first five postoperative days.
The procedures were performed by one of three orthopedic surgeons using a bone-patellar tendon-bone autograft harvested through a vertical anterior midline incision. The remainder of each procedure was performed arthroscopically. Intermittent passive range of motion was begun in the recovery room and continued for 2-h periods 3 times a day for 5 days. Patients all received general anesthesia (propofol induction followed by isoflurane and nitrous oxide), but no intraoperative opioids. Bupivacaine with epinephrine was injected subcutaneously before incision; the total dose was 2.5 mg/kg. Patients with severe pain (visual analog scale score of 5 or greater) were given intravenous fentanyl in the postanesthesia care unit; others were given 5 to 10 mg oxycodone tablets as needed. After discharge, patients were instructed to take acetaminophen (650 mg) with ketorolac (10 mg) or ibuprofen (600 mg) by mouth 4 times a day for 5 days. If they experienced any pain at rest or greater than minimal pain with activity, patients were instructed to take 5–10 mg oxycodone every 2 h.
Of 736 patients who had undergone AACLR, 58% had completed the 5-day questionnaire. Of these patients, women reported higher pain scores while at rest and during activity on the first postoperative day than did men. And, fewer women were able to perform the straight leg raising test. However, there was no difference in the amount of narcotics consumed by men and women at any time during the period evaluated. For example, 33.4% of women and 34.9% of men requested fentanyl in the postanesthesia care unit. The authors were unable to explain the reasons for different pain reporting in women, and conjectured that this may be caused by various factors, including behavioral patterns of reporting pain, heightened neuroprocessing of noxious stimuli in women, or varying effectiveness of the four analgesics used in this study.