Department of Orthopedics, Washington University/Barnes-Jewish Hospital, St Louis, Missouri 63110, USA.
Arthroscopy. 2010 Mar;26(3):404-16. doi: 10.1016/j.arthro.2009.08.014. Epub 2010 Jan 25.
The goal of this study was to determine whether femoral nerve blocks (FNBs) provide patients undergoing anterior cruciate ligament reconstruction greater pain relief or other benefits compared with more standard pain medication regimens.
We searched PubMed, EMBASE, and the Cochrane Database using the following search terms: "ACL or anterior cruciate ligament" and "femoral nerve block or peripheral nerve block" or "regional anesthesia." Thirteen studies were found that fit the inclusion criteria of being randomized controlled trials with a Level of Evidence of I or II, comparing FNB or 3-in-1 blocks with control groups undergoing various multimodal pain regimens.
Only 5 of the 13 studies found a significant difference in pain relief with FNB compared with the control groups; however, the difference in several of the studies may not be clinically relevant. Of the 13 studies, 6 examined parameters other than pain, and only 1 study found a greater incidence of nausea and sedation in its control group. Patient satisfaction was examined in 2 studies, with both finding no difference between groups. Nine studies used a single graft type, and the two studies using multiple graft types accounted for this in their analyses.
On the basis of the available Level I and II data from randomized controlled trials, there appears to be no evidence that FNBs add additional benefit over multimodal analgesia. FNBs have not been shown to significantly affect patient pain, readiness for discharge, or outcome scores. There is a small but identifiable risk associated with performing FNBs, with potentially catastrophic effects.
Level II, systematic review of Level I and II randomized controlled trials with minimal heterogeneity.
本研究旨在确定与更标准的疼痛药物治疗方案相比，股神经阻滞（FNB）是否能为接受前交叉韧带重建术的患者提供更大的疼痛缓解或其他益处。
我们使用以下搜索词在 PubMed、EMBASE 和 Cochrane 数据库中进行了搜索：“ACL 或前交叉韧带”和“股神经阻滞或外周神经阻滞”或“区域麻醉”。发现了 13 项符合纳入标准的研究，这些研究为随机对照试验，证据水平为 I 或 II 级，比较了 FNB 或 3-in-1 阻滞与接受各种多模式疼痛治疗方案的对照组。
只有 5 项研究发现 FNB 与对照组相比在缓解疼痛方面有显著差异；然而，在几项研究中，差异可能没有临床意义。在这 13 项研究中，有 6 项研究检查了除疼痛以外的参数，只有 1 项研究发现对照组恶心和镇静的发生率更高。有 2 项研究检查了患者满意度，两组之间均无差异。9 项研究使用了单一移植物类型，2 项研究使用了多种移植物类型的研究在其分析中考虑了这一点。
根据现有的 I 级和 II 级随机对照试验数据，似乎没有证据表明 FNB 比多模式镇痛有额外的益处。FNB 并未显著影响患者疼痛、出院准备或结果评分。进行 FNB 存在一定的风险，可能会产生灾难性的后果。
II 级，对 I 级和 II 级随机对照试验的系统评价，异质性较小。
