Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, 676 North St. Claire Avenue, Suite 1350, Chicago, IL 60611, USA.
J Bone Joint Surg Am. 2013 Aug 21;95(16):1465-72. doi: 10.2106/JBJS.L.01534.
With the rising use of outpatient knee arthroscopy over the past decade, interest in peripheral nerve blocks during arthroscopy has increased. Femoral nerve blocks are effective but are associated with an inherent risk of the patient falling postoperatively because of quadriceps weakness. We studied blocks of the infrapatellar branch of the saphenous nerve, which produce analgesia in the knee that is similar to that resulting from a femoral nerve block but without associated quadriceps weakness.
Thirty-four patients were enrolled into each arm of this prospective, randomized, double-blinded trial comparing 10 mL of 0.25% bupivacaine used as a block of the infrapatellar branch of the saphenous nerve with a placebo during simple knee arthroscopy. Immediate outcome measures included Numeric Rating Scale (NRS) pain scores (0 to 10 points), mobility and discharge times, opioid usage, subjective adverse side effects, and forty-eight-hour anesthesia recovery surveys. Short-term measures included one-week and twelve-week Lysholm knee scores.
No adverse effects or increased quadriceps weakness were observed following use of the nerve block. Improvement in early NRS scores and subjective nausea (p = 0.03) were detected. Patients for whom the block was successful also had improved twelve-week Lysholm knee scores (p = 0.04). No differences in opioid usage, mobility time, forty-eight-hour anesthesia recovery scores, or one-week Lysholm knee scores were found.
No significant adverse effect or disadvantage was identified for blocks of the infrapatellar branch of the saphenous nerve used in simple knee arthroscopy. In addition to decreased early NRS scores and nausea, blocks of the infrapatellar branch of the saphenous nerve demonstrated potential benefit at twelve weeks after simple knee arthroscopy.
在过去十年中，随着门诊膝关节镜检查的使用不断增加，对膝关节镜检查期间外周神经阻滞的兴趣也有所增加。股神经阻滞是有效的，但由于股四头肌无力，患者术后有跌倒的固有风险。我们研究了隐神经髌下支的阻滞，这种阻滞可以产生与股神经阻滞相似的膝关节镇痛作用，但没有股四头肌无力的相关风险。
本前瞻性、随机、双盲试验纳入了 34 例患者，分别在单纯膝关节镜检查中接受 10ml0.25%布比卡因隐神经髌下支阻滞和安慰剂阻滞。即刻评估指标包括数字评分量表（NRS）疼痛评分（0-10 分）、活动度和出院时间、阿片类药物使用、主观不良反应以及 48 小时麻醉恢复调查。短期评估指标包括术后一周和十二周的 Lysholm 膝关节评分。
使用神经阻滞后，未观察到不良反应或股四头肌无力增加。早期 NRS 评分和主观恶心改善（p=0.03）。阻滞成功的患者也有更好的十二周 Lysholm 膝关节评分（p=0.04）。阿片类药物使用、活动时间、48 小时麻醉恢复评分或术后一周 Lysholm 膝关节评分均无差异。
在单纯膝关节镜检查中使用隐神经髌下支阻滞没有明显的不良反应或不利影响。除了早期 NRS 评分和恶心减轻外，隐神经髌下支阻滞在单纯膝关节镜检查后十二周还可能具有潜在益处。
