Williams Brian A, Dang Qainyu, Bost James E, Irrgang James J, Orebaugh Steven L, Bottegal Matthew T, Kentor Michael L
Department of Anesthesiology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Anesth Analg. 2009 Apr;108(4):1296-302. doi: 10.1213/ane.0b013e318198d46e.
We previously reported that continuous perineural femoral analgesia reduces pain with movement during the first 2 days after anterior cruciate ligament reconstruction (ACLR, n = 270), when compared with multimodal analgesia and placebo perineural femoral infusion. We now report the prospectively collected general health and knee function outcomes in the 7 days to 12 wk after surgery in these same patients.
At three points during 12 wk after ACLR surgery, patients completed the SF-36 General Health Survey, and the Knee Outcome Survey (KOS). Generalized Estimating Equations were implemented to evaluate the association between patient-reported survey outcomes and (1) preoperative baseline survey scores, (2) time after surgery, and (3) three nerve block treatment groups.
Two hundred seventeen patients' data were complete for analysis. In univariate and multiple regression Generalized Estimating Equations models, nerve block treatment group was not associated with SF-36 and KOS scores after surgery (all with P > or = 0.05). The models showed that the physical component summary of the SF-36 (P < 0.0001) and the KOS total score (P < 0.0001) increased (improved) over time after surgery and were also influenced by baseline scores.
After spinal anesthesia and multimodal analgesia for ACLR, the nerve block treatment group did not predict SF-36 or knee function outcomes from 7 days to 12 wk after surgery. Further research is needed to determine whether these conclusions also apply to a nonstandardized anesthetic, or one that includes general anesthesia and/or high-dose opioid analgesia.
我们之前报道过，与多模式镇痛和股神经周围安慰剂输注相比，持续股神经周围镇痛可减轻前交叉韧带重建术后（ACLR，n = 270）头2天活动时的疼痛。我们现在报告这些相同患者术后7天至12周前瞻性收集的总体健康和膝关节功能结果。
在ACLR手术后12周内的三个时间点，患者完成了SF - 36总体健康调查和膝关节结果调查（KOS）。采用广义估计方程来评估患者报告的调查结果与（1）术前基线调查分数、（2）术后时间以及（3）三个神经阻滞治疗组之间的关联。
217例患者的数据完整可供分析。在单变量和多变量回归广义估计方程模型中，神经阻滞治疗组与术后SF - 36和KOS评分无关（均P≥0.05）。模型显示，术后SF - 36的身体成分总结（P < 0.0001）和KOS总分（P < 0.0001）随时间增加（改善），并且也受基线分数影响。
在ACLR采用脊髓麻醉和多模式镇痛后，神经阻滞治疗组不能预测术后7天至12周的SF - 36或膝关节功能结果。需要进一步研究以确定这些结论是否也适用于非标准化麻醉，或包括全身麻醉和/或高剂量阿片类镇痛的麻醉。
