Espelund M, Grevstad U, Jaeger P, Hölmich P, Kjeldsen L, Mathiesen O, Dahl J B
Department of Anaesthesiology, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark.
Acta Anaesthesiol Scand. 2014 Nov;58(10):1220-7. doi: 10.1111/aas.12407.
The analgesic effect of the adductor canal block (ACB) after knee surgery has been evaluated in a number of trials. We hypothesized that the ACB would provide substantial pain relief to patients responding with moderate to severe pain after arthroscopic knee surgery.
Fifty subjects with moderate to severe pain after arthroscopic knee surgery were enrolled in this placebo-controlled, blinded trial. All subjects received two ACBs; an initial ACB with either 30 ml ropivacaine 7.5 mg/ml (n = 25) (R group) or saline (n = 25) (C group) and after 45 min a second ACB with the opposite study medication, according to randomization. Primary outcome was pain during 45 degrees active flexion of the knee at 45 min after the first block, assessed on a 0-100 mm visual analogue scale. Secondary outcome measures were: pain at rest and during flexion of the knee, worst pain experienced during a 5-m walk, patient's evaluation of muscle strength during walk, and amount of sufentanil administered during the 90-min study period.
Regarding primary outcome, mean pain score difference between groups was 34 (95% CI: 25 to 44) mm, P < 0.001, in favour of the R group. At rest, mean pain score difference was 32 (23 to 41) mm, P < 0.001, and during walk: 21 (6 to 36) mm, P = 0.01 in favour of the R group. There were no differences between groups regarding other secondary outcome measures.
The ACB is a relevant option for patients with moderate to severe pain after arthroscopic knee surgery.
多项试验评估了膝关节手术后内收肌管阻滞（ACB）的镇痛效果。我们假设ACB能为膝关节镜手术后出现中度至重度疼痛的患者提供显著的疼痛缓解。
五十名膝关节镜手术后出现中度至重度疼痛的受试者参与了这项安慰剂对照、双盲试验。所有受试者均接受两次ACB；根据随机分组，初始ACB注射30毫升浓度为7.5毫克/毫升的罗哌卡因（n = 25）（R组）或生理盐水（n = 25）（C组），45分钟后注射另一种研究药物进行第二次ACB。主要结局指标为首次阻滞45分钟后膝关节主动屈曲45度时的疼痛，采用0 - 100毫米视觉模拟量表进行评估。次要结局指标包括：静息及膝关节屈曲时的疼痛、5米步行过程中经历的最严重疼痛、患者对步行时肌肉力量的评估以及90分钟研究期间舒芬太尼的给药量。
关于主要结局指标，两组之间的平均疼痛评分差异为34（95%置信区间：25至44）毫米，P < 0.001，R组更优。静息时，平均疼痛评分差异为32（23至41）毫米，P < 0.001；步行时为21（6至36）毫米，P = 0.01，R组更优。在其他次要结局指标方面，两组之间无差异。
对于膝关节镜手术后出现中度至重度疼痛的患者，ACB是一种有效的选择。
