Aikawa Katsuhiro, Hashimoto Toshikazu, Itosu Yusuke, Fujii Tomoaki, Horiguchi Takayuki, Amenomori Hidehiko, Morimoto Yuji
Masui. 2016 Jan;65(1):50-5.
Sciatic nerve block (SNB) is widely used as a supplemental analgesia after total knee arthroplasty (TKA) combined with femoral nerve block (FNB). Despite its effectiveness, SNB often causes peroneal nerve paralysis, which makes it difficult to detect peroneal nerve injury by surgical process. Recently, periarticular infiltration analgesia (PIA) is reported that it provides analgesia without peroneal nerve paralysis. We conducted a retrospective analysis to compare the effectiveness of SNB and PIA.
This study was approved by the local institutional ethics committee; 17 patients undergoing TKA under general anesthesia with continuous femoral nerve block were enrolled in the study. All patients received continuous FNB. Nine patients received sciatic nerve block successively, while 8 patients received PIA around the time of insertion of artificial joint. Primary outcome measure was the frequency of peroneal nerve paralysis when the patients woke up. Secondary outcome measures included numerical rating scale (NRS) until postoperative day 3.
While there were 6 patients who had peroneal nerve paralysis in the SNB group, none of them had it in the PIA group (P = 0.009). There were no significant differences of the NRSs between the two groups.
PIA provided sufficient analgesia after TKA without peroneal nerve paralysis.
坐骨神经阻滞（SNB）作为全膝关节置换术（TKA）后联合股神经阻滞（FNB）的辅助镇痛方法被广泛应用。尽管其效果显著，但SNB常导致腓总神经麻痹，这使得在手术过程中难以检测到腓总神经损伤。最近，有报道称关节周围浸润镇痛（PIA）可提供镇痛且不会导致腓总神经麻痹。我们进行了一项回顾性分析以比较SNB和PIA的有效性。
本研究经当地机构伦理委员会批准；纳入17例在全身麻醉下行TKA并接受连续股神经阻滞的患者。所有患者均接受连续FNB。9例患者先后接受坐骨神经阻滞，而8例患者在人工关节植入时接受PIA。主要观察指标是患者苏醒时腓总神经麻痹的发生率。次要观察指标包括术后第3天前的数字评分量表（NRS）。
SNB组有6例患者发生腓总神经麻痹，而PIA组无1例发生（P = 0.009）。两组的NRS无显著差异。
PIA在TKA后可提供充分的镇痛且不会导致腓总神经麻痹。
