Espelund M, Fomsgaard J S, Haraszuk J, Dahl J B, Mathiesen O
Department of Anaesthesiology, Glostrup Hospital, University of Copenhagen, Glostrup, Denmark.
Acta Anaesthesiol Scand. 2014 Mar;58(3):273-80. doi: 10.1111/aas.12224. Epub 2013 Nov 8.
Adductor canal blockade (ACB) has been demonstrated to be effective in the treatment of post-operative pain after major knee surgery. We hypothesised that the ACB would reduce pain and analgesic requirements after minor arthroscopic knee surgery.
Seventy-two patients scheduled for minor knee surgery were enrolled in this placebo-controlled, blinded trial. The patients were randomised to receive an ACB with either 30 ml ropivacaine 7.5 mg/ml (n = 36) or saline (n = 35) in addition to a basic analgesic regimen with paracetamol and ibuprofen. Primary outcome measure was pain during standing at 2 h after surgery. Secondary outcomes were pain at rest, while standing and after a 5-m walk; opioid consumption and opioid-related side effects 0-24 h after surgery.
Pain scores {median [interquartile range (IQR)]}, regarding primary outcome were 15 (0-26) mm in the ropivacaine vs. 17 (5-28) mm in the control group, 95% confidence interval (CI) (-10 to 4) mm, P = 0.41. Ketobemidone consumption 0-2 h post-operatively [median (IQR)] was lower in the ropivacaine vs. the control group: 0.0 (0.0-2.5) mg vs. 2.5 (0.0-5.0) mg, 95% CI: -2.5 to 0 mg, P = 0.01. No differences were observed for any other outcome.
No significant analgesic effect of the ACB could be detected after minor arthroscopic knee surgery with a basic analgesic regimen with acetaminophen and ibuprofen, except from a minor reduction in immediate requirements for supplemental opioids. Clinicaltrials.gov Identifier: NCT01254825.
内收肌管阻滞（ACB）已被证明在治疗膝关节大手术后的术后疼痛方面有效。我们假设ACB会减轻膝关节小关节镜手术后的疼痛并减少镇痛需求。
72例计划进行膝关节小手术的患者参加了这项安慰剂对照、双盲试验。患者被随机分配接受30毫升浓度为7.5毫克/毫升的罗哌卡因（n = 36）或生理盐水（n = 35）的ACB，同时接受对乙酰氨基酚和布洛芬的基本镇痛方案。主要结局指标是术后2小时站立时的疼痛。次要结局指标是静息时、站立时和步行5米后的疼痛；术后0至24小时的阿片类药物消耗量和阿片类药物相关副作用。
关于主要结局指标，罗哌卡因组的疼痛评分{中位数[四分位间距（IQR）]}为15（0 - 26）毫米，而对照组为17（5 - 28）毫米，95%置信区间（CI）为（-10至4）毫米，P = 0.41。罗哌卡因组术后0至2小时的酮咯酸消耗量[中位数（IQR）]低于对照组：0.0（0.0 - 2.5）毫克对2.5（0.0 - 5.0）毫克，95% CI：-2.5至0毫克，P = 0.01。其他任何结局指标均未观察到差异。
在使用对乙酰氨基酚和布洛芬的基本镇痛方案进行膝关节小关节镜手术后，除了补充阿片类药物的即时需求略有减少外，未检测到ACB有显著的镇痛效果。Clinicaltrials.gov标识符：NCT01254825。
