Mangar Devanand, Karlnoski Rachel A, Sprenker Collin J, Downes Katheryne L, Taffe Narrene, Wainwright Robert, Gustke Kenneth, Bernasek Thomas L, Camporesi Enrico
Florida Gulf to Bay Anesthesiology Associates LLC, 1 Tampa General Circle, Suite A327, Tampa, FL, 33606, USA.
J Anesth. 2014 Apr;28(2):214-21. doi: 10.1007/s00540-013-1700-y. Epub 2013 Aug 25.
Despite providing adequate pain relief, a femoral nerve block can induce postoperative muscle weakness after total knee arthoplasty (TKA). Fentanyl has been shown to have peripheral effects but has not been used as a perineural infusate alone after TKA.
Sixty patients scheduled for TKA were randomized to one of three blinded groups: a continuous 24 h infusion of either fentanyl 3 μg/ml, ropivacaine 0.1%, or 0.9% normal saline through a femoral nerve sheath catheter at 10 ml/h. The main outcome was maximum voluntary isometric contraction (MVIC) in the quadriceps femoris (knee extension), measured by a handheld dynamometer (Nm/kg). Other variables assessed were preoperative and postoperative visual analog scale (VAS) scores, hamstrings MVIC (knee flexion), active range of motion of the operative knee, distance ambulated, incidence of knee buckling, supplemental morphine usage, postoperative side effects, and serum fentanyl levels.
Quadriceps MVIC values were significantly greater in the fentanyl group compared to the group that received ropivacaine (median values, 0.08 vs. 0.03 Nm/kg; p = 0.028). The incidence of postoperative knee buckling upon ambulation was higher in the ropivacaine group compared to the fentanyl group, although not statistically significant (40% vs. 15 %, respectively; p = 0.077). VAS scores while ambulating were not significantly different between the fentanyl group and the ropivacaine group (p = 0.270). Postoperative morphine consumption, nausea and vomiting, and resting VAS scores were similar among the three groups.
A continuous perineural infusion of fentanyl produced greater strength retention than ropivacaine post-TKA.
尽管股神经阻滞能提供充分的疼痛缓解，但全膝关节置换术（TKA）后仍可诱发术后肌肉无力。芬太尼已被证明具有外周效应，但尚未单独用作TKA后的神经周围输注液。
将60例计划行TKA的患者随机分为三个盲法组之一：通过股神经鞘导管以10ml/h的速度持续24小时输注3μg/ml芬太尼、0.1%罗哌卡因或0.9%生理盐水。主要结局是通过手持测力计（Nm/kg）测量股四头肌（膝关节伸展）的最大自主等长收缩（MVIC）。评估的其他变量包括术前和术后视觉模拟量表（VAS）评分、腘绳肌MVIC（膝关节屈曲）、手术膝关节的主动活动范围、行走距离、膝关节屈曲发生率、补充吗啡用量、术后副作用和血清芬太尼水平。
与接受罗哌卡因的组相比，芬太尼组的股四头肌MVIC值显著更高（中位数分别为0.08 vs. 0.03 Nm/kg；p = 0.028）。与芬太尼组相比，罗哌卡因组行走时术后膝关节屈曲的发生率更高，尽管无统计学意义（分别为40% vs. 15%；p = 0.077）。芬太尼组和罗哌卡因组行走时的VAS评分无显著差异（p = 0.270）。三组术后吗啡消耗量、恶心呕吐和静息VAS评分相似。
TKA后持续神经周围输注芬太尼比罗哌卡因能更好地保留肌力。
