Department of Anaesthesia, Valais Hospital, Sion, Switzerland.
Department of Anaesthesia, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
Anaesthesia. 2016 Oct;71(10):1198-209. doi: 10.1111/anae.13568. Epub 2016 Jul 29.
The aim of this meta-analysis was to assess the postoperative analgesic efficacy of sciatic nerve block when combined with femoral nerve block after total knee arthroplasty. Outcomes included resting pain scores (analogue scale, 0-100), intravenous morphine consumption at 12 h, 24 h and 48 h postoperatively, and functional outcomes comprising knee flexion, distance walked, and length of stay. Twelve randomised controlled trials were included, with a total of 600 patients. When combined with femoral nerve block, sciatic nerve block significantly reduced resting pain scores at 12 h postoperatively with a mean difference of 10 (95% CI: -15 to -5; p < 0.00001). Resting pain scores at 24 h, and intravenous morphine consumption at 12 h, 24 h and 48 h postoperatively were also significantly reduced, but without clinical significance beyond 12 h and without affecting functional outcomes. In conclusion, sciatic nerve block confers additional postoperative analgesia within the first 12 postoperative hours compared with femoral nerve block alone for patients undergoing total knee arthroplasty.
本荟萃分析的目的是评估全膝关节置换术后股神经阻滞联合坐骨神经阻滞的术后镇痛效果。结果包括静息疼痛评分（模拟评分，0-100）、术后 12 小时、24 小时和 48 小时静脉吗啡消耗量以及包括膝关节屈曲、行走距离和住院时间在内的功能结果。共纳入 12 项随机对照试验，共 600 例患者。与股神经阻滞联合应用时，坐骨神经阻滞可显著降低术后 12 小时的静息疼痛评分，平均差值为 10（95%CI：-15 至-5；p<0.00001）。术后 24 小时的静息疼痛评分以及术后 12 小时、24 小时和 48 小时的静脉吗啡消耗量也显著降低，但在 12 小时后无临床意义，且不影响功能结果。总之，与单独行股神经阻滞相比，在全膝关节置换术后的最初 12 小时内，坐骨神经阻滞可提供额外的术后镇痛效果。
