Faunø Peter, Lund Bent, Christiansen Svend Erik, Gjøderum Ole, Lind Martin
Department of Sports Traumatology, Aarhus University Hospital, Aarhus, Denmark.
Department of Sports Traumatology, Aarhus University Hospital, Aarhus, Denmark.
Arthroscopy. 2015 Jan;31(1):63-8. doi: 10.1016/j.arthro.2014.07.024. Epub 2014 Sep 17.
To evaluate the effect of a hamstring block for postoperative pain management using 20 mL of 0.25% bupivacaine compared with placebo after anterior cruciate ligament (ACL) reconstruction with a hamstring autograft.
In a 3-month period, 45 patients undergoing ACL reconstruction with a hamstring autograft who all received a femoral nerve block were randomized to receive either 20 mL of 0.25% bupivacaine or 20 mL of saline water administered through a catheter into the donor-site space. The patients and recovery staff were blinded to the treatment. Postoperative donor-site pain was evaluated subjectively by the patients using a pain score (Likert scale from 0 to 10). The pain was registered for each hour in the first 6 hours and thereafter once daily for 8 days. Furthermore, the requirement for postoperative analgesic medicine was registered.
The hamstring block group (n = 23) had significantly less pain for each of the first 6 postoperative hours. The pain score was reduced from 4.2 to 2.3 (95% confidence interval, 1.3 to 3.3) (P = .01) in the first hour and from 2.8 to 1.3 (95% confidence interval, 0.6 to 1.9) in the sixth hour, and there was a significantly lower overall requirement for early postoperative fentanyl, reduced from a mean of 58 to 35 μg (P = .02), and morphine, reduced from a mean of 10 to 6 mg (P = .04). After 6 hours, there was no difference in the pain level and use of analgesics between the 2 groups.
With the use of a donor-site block in hamstring ACL reconstruction, the donor-site pain level, as well as the overall requirement for fentanyl and morphine, was significantly reduced in the first 6 postoperative hours. No effect of the donor-site block was seen after 6 hours.
Level I, therapeutic, randomized controlled study.
在自体腘绳肌肌腱重建前交叉韧带（ACL）后，评估使用20毫升0.25%布比卡因进行腘绳肌阻滞与安慰剂相比对术后疼痛管理的效果。
在3个月的时间里，45例接受自体腘绳肌肌腱重建ACL且均接受股神经阻滞的患者被随机分为两组，分别通过导管向供区间隙注入20毫升0.25%布比卡因或20毫升生理盐水。患者和康复人员对治疗分组不知情。术后供区疼痛由患者使用疼痛评分（0至10分的李克特量表）进行主观评估。在术后的前6小时内每小时记录一次疼痛情况，之后8天每天记录一次。此外，记录术后镇痛药的使用需求。
腘绳肌阻滞组（n = 23）在术后的前6小时内，每小时的疼痛程度均显著减轻。在第1小时，疼痛评分从4.2降至2.3（95%置信区间为1.3至3.3）（P = 0.01），在第6小时从2.8降至1.3（95%置信区间为0.6至1.9），且术后早期芬太尼的总体使用需求显著降低，从平均58微克降至35微克（P = 0.02），吗啡的使用需求也显著降低，从平均10毫克降至6毫克（P = 0.04）。6小时后，两组之间的疼痛程度和镇痛药使用情况无差异。
在腘绳肌肌腱重建ACL时使用供区阻滞，术后前6小时供区疼痛程度以及芬太尼和吗啡的总体使用需求均显著降低。6小时后未观察到供区阻滞的效果。
I级，治疗性随机对照研究。
