Optimising day‐case analgesia for anterior cruciate ligament reconstruction – a reply
Bibliographic record
Abstract
We would like to thank Dr Mughal and Dr Jagannathan for their thoughtful comments regarding our recent meta-analysis comparing the analgesic efficacy of local infiltration analgesia with femoral nerve block after anterior cruciate ligament (ACL) reconstruction 1. Their comment brings attention to the evolving paradigm of regional anaesthesia and its impact on patient function. Although previously widely accepted that regional anaesthesia improves functional outcomes 2, 3, more recent contrary arguments incriminate blocks as responsible for hindered mobility and falls 4. One result is the growing adoption of alternative techniques such as local infiltration analgesia, even if the suggested solutions are not yet strongly evidence-based 5. However, a large and recent database study including close to 200,000 patients argued that regional blocks do not increase risk of postoperative falls 6. Finally, we would like to emphasise that, even without femoral nerve block, patients may develop quadriceps paraesthesia for at least four weeks after anterior cruciate ligament reconstruction 7. Furthermore, factors other than femoral nerve block may contribute to quadriceps muscle weakness after ACL surgery, including the tourniquet 8, loss of mechanoreceptors in the anterior band 9 and reduced activity of the gamma loop 10. Mughal and Jagannathan argue that Mehdi et al. found similar analgesia between groups without impact on length of stay 11. The main purpose of a meta-analysis is to resolve conflicting results from different randomised controlled trials, and therefore we believe our results provide superior evidence. Regarding functional assessment, we also considered including length of stay, but unfortunately none of the included trials specifically reported functional outcomes, preventing us drawing meaningful conclusion regarding the impact of the analgesic technique on functional recovery. Of note, local infiltration analgesia is associated with chondrotoxicity and chondrolysis 12, which might severely impair the function of young adults 13. We agree with Mughal and Jagannathan that we should aim for optimal rather than ideal analgesia. Based on the results of our meta-analysis and the aforementioned arguments, we confirm our conclusion that femoral nerve block provides superior postoperative analgesic efficacy after ACL reconstruction when compared with local infiltration analgesia.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".