Design: Double-blind, sham-controlled randomised trial
Population: 100 adults undergoing ACL reconstruction under general anaesthesia
Primary outcome: Opioid consumption in the first 24 hours
Effect: No significant difference with block vs sham (p = 0.109); pain, straight-leg raise and recovery scores similar

In a double-blind trial, 100 adults having anterior cruciate ligament reconstruction under general anaesthesia all received local infiltration analgesia, and were randomised to an adductor canal block or a sham saline injection.

Opioid use in the first 24 hours, the primary outcome, did not differ significantly. Nor did pain scores at 24 hours, the ability to straight-leg raise at three hours, quality of recovery on day one, or knee scores at one week. Intraoperative opioid use was also similar.

The trial is modest in size and from one centre, and the abstract reports p-values rather than effect sizes, so a small benefit cannot be excluded. But it gives no support to adding a block routinely when good local infiltration is used, which saves time, cost and a second needle. It was published in August 2026.

When good local infiltration analgesia is used for ACL reconstruction, a routine adductor canal block may add little.
Keep the block for patients with specific reasons, such as high opioid sensitivity or failed infiltration.
Quadriceps function at three hours was similar with or without the block.
Agree a unit analgesia protocol with anaesthesia rather than adding blocks case by case.

Why it matters

A routine second procedure may be cost and time without measurable benefit.

The statistics, in plain English

A non-significant result (p = 0.11 for opioid use) means the trial did not show a difference, not that it proved there is none. With 50 patients per arm, a small benefit could be missed. The abstract did not give confidence intervals, which would show how large an effect is still possible.