Gao Fuqiang, Ma Jinhui, Sun Wei, Guo Wanshou, Li Zirong, Wang Weiguo
*Department of Orthopaedic Surgery, Center for Osteonecrosis and Joint Preserving & Reconstruction †Peking University, China-Japan Friendship School of Clinical Medicine, Beijing, China.
Clin J Pain. 2017 Apr;33(4):356-368. doi: 10.1097/AJP.0000000000000402.
The efficacy and safety of adductor canal block (ACB) as compared with femoral nerve block (FNB) for postoperative pain management in total knee arthroplasty (TKA) remains controversial. We therefore performed a meta-analysis of randomized-controlled trials (RCTs) to compare ACB with FNB in TKA.
Databases, including Pubmed, Medline, Embase, Web of Science, and Cochrane library were searched to identify RCTs comparing ACB with FNB for pain management in patients undergoing TKA. The primary outcomes included pain score with rest or activity and opioid consumption. Secondary outcomes were mobilization ability, quadriceps strength and grade, length of hospital stay, and complications (nausea or vomiting).
A total of 573 TKAs in 514 patients from 7 RCTs were included in the meta-analysis. Two studies with 155 TKAs reported the mobilization ability assessed by Timed Up and Go Test. The ACB patients performed significantly faster than the FNB patients in the early postoperative period (mean difference=-5.08; 95% confidence interval, -6.03 to -4.13; P<0.00001). The subgroup analysis showed that the outcomes of pain, morphine consumption, quadriceps strength, and length of hospital stay in single shot and continuous subgroups were not statistically different between the 2 groups (P>0.05).
ACB may achieve faster mobilization ability recovery for patients after TKA without a reduction in analgesia when compared with FNB in the early postoperative period. However, due to the variations in the included studies, additional studies are needed to validate these conclusions.
与股神经阻滞（FNB）相比，收肌管阻滞（ACB）用于全膝关节置换术（TKA）术后疼痛管理的有效性和安全性仍存在争议。因此，我们进行了一项随机对照试验（RCT）的荟萃分析，以比较TKA中ACB与FNB的效果。
检索包括Pubmed、Medline、Embase、科学网和Cochrane图书馆在内的数据库，以确定比较ACB与FNB用于TKA患者疼痛管理的RCT。主要结局包括静息或活动时疼痛评分及阿片类药物消耗量。次要结局为活动能力、股四头肌力量及分级、住院时间和并发症（恶心或呕吐）。
荟萃分析纳入了来自7项RCT的514例患者的573例TKA。两项共155例TKA的研究报告了通过计时起立行走测试评估的活动能力。ACB组患者术后早期的表现明显快于FNB组患者（平均差值=-5.08；95%置信区间，-6.03至-4.13；P<0.00001）。亚组分析显示，单次注射和连续注射亚组中，两组在疼痛、吗啡消耗量、股四头肌力量和住院时间方面的结局无统计学差异（P>0.05）。
与FNB相比，ACB在TKA术后早期可能使患者更快恢复活动能力，且不降低镇痛效果。然而，由于纳入研究存在差异，需要更多研究来验证这些结论。
