Post ACL Surgery Pain Management

Strategies for managing pain throughout the recovery process.

Immediate Post-Operative Pain

Managing pain effectively in the first days after surgery is crucial for comfort and early rehabilitation participation.

During Your Surgery

It’s likely that in addition to any general anesthesia used for surgery, that local anesthetics are used as well. Local anesthetics are intended to target a specific area of the body. For something simple, such as sutures / stitches after a cut, things like lidocaine may be used. This helps block brain signals and has other effects. There are several similar drugs. While these don’t typically have the same level of side effects of general anesthetics, their may be risks of allergic reactions, ideally avoided based on your doctor’s understanding of your medical history. For things like ACL surgery, other medicines are likely used for anesthetics as they’re longer lasting, possibly such drugs as Bupivacaine and Ropivacaine.

Local and Regional anesthetics can relieve pain during a procedure and for hours afterward. These might even be used for procedures where a patient remains conscious / awake. When a nerve block technique is used, an anesthetic is typically injected near a specific nerve or group of nerves to block pain signals from traveling to the brain. For something like ACL surgery, nerve block injections can use ultrasound guidance for precision. With this technique an ultrasound machine can provide real-time images of underlying structures like nerves, muscles, and blood vessels. Your clinician can visually identify nerves on a screen, and using a thin needle, guide it’s path directly to a target spot, at which point the anesthetic can be injected. Such treatments will typically last from several to 24 hours, but possibly longer. And may also result in further partial numbness as a residual effect.

Post Surgery

• Medication approaches:
  
  • Multimodal analgesia combining different medication types.
  • Scheduled non-opioid medications (acetaminophen, NSAIDs when appropriate, but may be delayed.)
  • Limited opioid use for breakthrough pain.
  • Regional anesthesia techniques (nerve blocks) for initial post-operative period.
  • If periods of pain feel overwhelming, get in touch with your healthcare provider and ask about adjusting / increasing dosage, (or other options), which may only be needed for several hours to a day or so in order to get past an especially challenging period.
    
• Non-pharmaceutical approaches:
  
  • RICE protocol (Rest, Ice, Compression, Elevation).
  • Cryotherapy (cold therapy) devices (for controlling inflammation, typically just after event(s) that cause it, such as a therapy session or exercise.
  • Proper positioning and bracing.
  • Warm water hydrotherapy. (Who doesn’t like an excuse for a long, hot shower.)
    
  • Note: Cold and Heat operate in different ways… and going from one to another quickly might not be useful. Going from cold to hot, for example, could reverse the cold effect too quickly, aggravating swelling. In later recovery stages, there is something called “contrast therapy” used intentionally to go back and forth. The idea is to stimulate circulation, reduce swelling and relieve stiffness. But it needs to be done purposefully and timed appropriately. Bottom Line: In early stages with acute inflammation, it’s probably best to stick with cold. Later, (at least 30 minutes or so), a hot shower may help. But not so immediately after cold to reverse the benefits of the cold therapy.

Pain During Rehabilitation

As recovery progresses, pain management strategies evolve:

• Activity modification: Finding the balance between therapeutic stress and excessive pain.
• Timing medication: Strategic use before challenging therapy sessions.
• Physical modalities: Appropriate use of ice, heat, and other physical therapy modalities.
• Addressing muscle soreness: Distinguishing between therapeutic discomfort and problematic pain.
• Gradual progression: Systematic advancement of exercises to allow tissue adaptation.

Managing Chronic Pain

For persistent pain beyond expected recovery timeframes:

• Identifying sources: Differential diagnosis of pain generators (graft site, donor site, patellofemoral, etc.)
• Advanced imaging: When needed to rule out complications.
• Specialized interventions: Including targeted physical therapy approaches, appropriate injections, or referral to pain specialists.
• Addressing contributing factors: Such as movement patterns, muscle imbalances, or kinesiophobia.

Alternative Pain Management Methods

Alternative and complementary pain management methods can play a valuable role alongside traditional medications. Acupuncture has shown benefit for some in reducing post-operative pain and opioid use. Mind-body techniques such as guided breathing, meditation, or progressive muscle relaxation can help lower pain perception and reduce stress, which may otherwise amplify discomfort. Gentle massage (away from the surgical site), music therapy, and distraction techniques may also support a more comfortable recovery. Always discuss these options with your care team to ensure they complement your primary treatment plan safely.

Regarding CBD (cannabidiol) and cannabis-derived compounds, I haven’t been able to find definitive information on this. The closest I’ve come is this: Cannabinoids and orthopedic surgery: a systematic review of therapeutic studies. So it may be useful for some in terms of pain relief. And may help moderate inflammation, but may also possibly over-suppress inflammation, which is potentially bad. Another benefit might be if CBD helps with sleep and anxiety, which can help recovery in general. Another potential risk of CBDs is that whatever the source may be, similar to herbal supplements, the formulations may vary widely and be of hard to judge quality or be challenging to determine dosing. This definitely falls under the list of “Talk to your doctor.”

Complementary Approaches

Patients may benefit from integrating complementary strategies:

• Psychological support: Addressing anxiety, catastrophizing, and other factors that can amplify pain.
• Mind-body techniques: Including relaxation training, mindfulness, and guided imagery.
• Sleep optimization: Addressing sleep quality to improve pain tolerance and healing.
• Appropriate nutrition: Managing inflammation through diet.
• Acupuncture: Evidence supports benefits for some patients.