Okoroha Kelechi R, Keller Robert A, Marshall Nathan E, Jung Edward K, Mehran Nima, Owashi Eric, Moutzouros Vasilios
Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A..
Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A.
Arthroscopy. 2016 Sep;32(9):1838-45. doi: 10.1016/j.arthro.2016.05.033. Epub 2016 Jun 24.
To compare femoral nerve block (FNB) versus local liposomal bupivacaine (LB) for pain control in patients undergoing anterior cruciate ligament (ACL) reconstruction.
Eighty-five patients undergoing primary ACL reconstruction were assessed for participation. We performed a prospective randomized trial in accordance with the CONSORT (Consolidated Standards of Reporting Trials) 2010 statement. The study arms included either intraoperative local infiltration of LB (20 mL of bupivacaine/10 mL of saline solution) or preoperative FNB with a primary outcome of postoperative pain levels (visual analog scale) for 4 days. Secondary outcomes assessed included opioid consumption (intravenous morphine equivalents), hours slept, patient satisfaction, and calls to the physician. Randomization was by a computerized algorithm. The observer was blinded and the patient was not blinded to the intervention.
One patient declined participation; 2 patients were excluded after randomization. A total of 82 patients were analyzed. Outcomes showed a significant increase in pain in the LB group between 5 and 8 hours postoperatively (mean ± standard deviation, 6.3 ± 2.0 versus 4.8 ± 2.6; P = .01). There were no significant differences between the groups in mean daily pain levels, morphine equivalents, or patient satisfaction when we controlled for graft type, age, body mass index, and sex. Patients receiving an FNB had a nonsignificant increase in number of sleep disturbances on the day of surgery (mean ± standard deviation, 4.4 ± 3.7 v 3.1 ± 2.1; P = .09) and were more likely to call their doctor the following day because of pain (29% v 8%, P = .04). Six patients in the FNB group had either prolonged quadriceps inhibition or sensory disturbance. One patient in the LB group required reoperation for a flexion contracture.
An increase in acute postoperative pain was found with LB compared with FNB for post-ACL reconstruction pain control. After the acute postoperative period, there were no significant differences in opioid consumption or pain control. The occurrence of nerve irritation postoperatively was found to be higher in the FNB group.
Level I, prospective randomized trial.
比较股神经阻滞（FNB）与局部脂质体布比卡因（LB）在接受前交叉韧带（ACL）重建手术患者的疼痛控制效果。
评估85例接受初次ACL重建手术的患者是否参与。我们依据2010年CONSORT（综合报告试验标准）声明进行了一项前瞻性随机试验。研究组包括术中局部浸润LB（20毫升布比卡因/10毫升盐溶液）或术前FNB，主要观察指标为术后4天的疼痛程度（视觉模拟评分）。评估的次要观察指标包括阿片类药物消耗量（静脉注射吗啡当量）、睡眠时间、患者满意度以及联系医生的次数。随机分组采用计算机算法。观察者设盲，患者未对干预措施设盲。
1例患者拒绝参与；2例患者在随机分组后被排除。共分析了82例患者。结果显示，LB组术后5至8小时疼痛显著增加（均值±标准差，6.3±2.0对4.8±2.6；P = 0.01）。在控制移植物类型、年龄、体重指数和性别后，两组在每日平均疼痛程度、吗啡当量或患者满意度方面无显著差异。接受FNB的患者在手术当天睡眠障碍数量有非显著增加（均值±标准差，4.4±3.7对3.1±2.1；P = 0.09），且次日因疼痛联系医生的可能性更高（29%对8%，P = 0.04）。FNB组有6例患者出现股四头肌抑制延长或感觉障碍。LB组有1例患者因屈曲挛缩需要再次手术。
与FNB相比，LB用于ACL重建术后疼痛控制时，术后急性疼痛增加。术后急性期过后，阿片类药物消耗量或疼痛控制方面无显著差异。FNB组术后神经刺激的发生率更高。
I级，前瞻性随机试验。
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