通过肌电图评估内收肌管内局部麻醉药容量对股四头肌功能的影响：一项在志愿者中进行的随机、观察者和受试者双盲、安慰剂对照研究。

The Effect of Local Anesthetic Volume Within the Adductor Canal on Quadriceps Femoris Function Evaluated by Electromyography: A Randomized, Observer- and Subject-Blinded, Placebo-Controlled Study in Volunteers.

作者信息

Grevstad Ulrik, Jæger Pia, Sørensen Johan Kløvgaard, Gottschau Bo, Ilfeld Brian, Ballegaard Martin, Hagelskjaer Mike, Dahl Jørgen Berg

机构信息

From the *Department of Anaesthesia and Intensive Care Medicine, Copenhagen University Hospital, Gentofte Hospital, Hellerup, Denmark; †Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Denmark; ‡Department of Anesthesiology, University California San Diego, San Diego, California; and §Department of Clinical Neurophysiology, Rigshospitalet, Copenhagen, Denmark.

出版信息

Anesth Analg. 2016 Aug;123(2):493-500. doi: 10.1213/ANE.0000000000001310.

DOI:10.1213/ANE.0000000000001310

PMID:27159069

Abstract

BACKGROUND

Single-injection adductor canal block (ACB) provides analgesia after knee surgery. Which nerves that are blocked by an ACB and what influence-if any-local anesthetic volume has on the effects remain undetermined. We hypothesized that effects on the nerve to the vastus medialis muscle (which besides being a motor nerve innervates portions of the knee) are volume-dependent.

METHODS

In this assessor- and subject-blinded randomized trial, 20 volunteers were included. On 3 separate days, subjects received an ACB with different volumes (10, 20, and 30 mL) of lidocaine 1%. In addition, they received a femoral nerve block and a placebo ACB. The effect on the vastus medialis (primary endpoint) and the vastus lateralis was evaluated using noninvasive electromyography (EMG). Quadriceps femoris muscle strength was evaluated using a dynamometer.

RESULTS

There was a statistically significant difference in EMG response from the vastus medialis, dependent on volume. Thirty-five percent (95% confidence interval [CI], 18-57) of the subjects had an affected vastus medialis after an ACB with 10 mL compared with 84% (95% CI, 62-94) following 20 mL (P = 0.03) and 100% (95% CI, 84-100) when 30 mL was used (P = 0.0001). No statistically significant differences were found between volume and effect on the vastus lateralis (P = 0.81) or in muscle strength (P = 0.15).

CONCLUSIONS

For ACB, there is a positive correlation between local anesthetic volume and effect on the vastus medialis muscle. Despite the rather large differences in EMG recordings, there were no statistically significant differences in quadriceps femoris muscle strength. Subsequent clinical studies comparing different volumes in a surgical setting, powered to show differences not only in analgesic efficacy, but also in adverse events, are required.

摘要

背景

单次注射股内收肌管阻滞（ACB）可在膝关节手术后提供镇痛效果。ACB阻滞了哪些神经以及局部麻醉药的剂量对其效果有何影响（若有影响）仍不明确。我们推测，对股内侧肌神经（该神经除作为运动神经外，还支配膝关节的部分区域）的影响取决于剂量。

方法

在这项评估者和受试者双盲的随机试验中，纳入了20名志愿者。在3个不同的日子里，受试者分别接受了不同剂量（10、20和30毫升）的1%利多卡因进行ACB。此外，他们还接受了股神经阻滞和安慰剂ACB。使用无创肌电图（EMG）评估对股内侧肌（主要终点）和股外侧肌的影响。使用测力计评估股四头肌力量。

结果

股内侧肌的EMG反应在统计学上存在显著差异，取决于剂量。与使用20毫升后84%（95%置信区间[CI]，62 - 94）的受试者股内侧肌受影响相比，使用10毫升ACB后，35%（95% CI，18 - 57）的受试者股内侧肌受影响（P = 0.03），而使用30毫升时为100%（95% CI，84 - 100）（P = 0.0001）。在剂量与对股外侧肌的影响（P = 0.81）或肌肉力量（P = 0.15）之间未发现统计学上的显著差异。