前交叉韧带重建术后关节周围局部浸润镇痛与股神经阻滞用于术后疼痛控制的前瞻性、比较性、非劣效性研究。
Peri-articular local infiltration analgesia versus femoral nerve block for postoperative pain control following anterior cruciate ligament reconstruction: Prospective, comparative, non-inferiority study.
作者信息
Lefevre N, Klouche S, de Pamphilis O, Herman S, Gerometta A, Bohu Y
机构信息
Clinique du Sport, 75005 Paris, France; Institut de l'Appareil Locomoteur Nollet, 75017 Paris, France.
Clinique du Sport, 75005 Paris, France; Institut de l'Appareil Locomoteur Nollet, 75017 Paris, France.
出版信息
Orthop Traumatol Surg Res. 2016 Nov;102(7):873-877. doi: 10.1016/j.otsr.2016.07.011. Epub 2016 Oct 4.
INTRODUCTION
Femoral nerve block (FNB) is considered as a major advance in anterior cruciate ligament (ACL) reconstruction as it reduces the need for parenteral opioids. However, the incidence of transient or even permanent neurological deficits due to the FNB is estimated at 1.94% after knee surgery. The primary objective of this study was to compare local infiltration analgesia (LIA) to FNB during ACL reconstruction procedures. The study hypothesis was that LIA was not less effective than FNB on early postoperative pain.
PATIENTS AND METHODS
A retrospective analysis of data collected prospectively in the FAST cohort included a series of continuous patients who underwent primary repair for isolated ACL with a hamstring graft in 2013-2014. Changes in our anesthesia practices over time allowed us to form three successive groups: Group 1 - FNB, Group 2 - FNB+LIA, Group 3 - LIA only. Ultrasound-guided FNB was done pre-operatively. The LIA was done at the end of the procedure by the surgeon with systematic infiltration of all skin incisions and the hamstring donor site; no intra-articular injections were performed. The primary endpoint was the average early postoperative pain (Days 0-3) described by the patient on a visual analogue scale (0-10). Sample size calculation pointed to 36 subjects being needed per group for a non-inferiority study.
RESULTS
The study involved 126 patients: G1=42, G2=38, G3=46. The patients were comparable at enrolment. The average early postoperative pain levels were 3.1±2.4, 2.8±2.0 and 2.5±2.2, respectively (P=0.66). A trend toward higher intake of tramadol was noted in the LIA group on D0 to D3, with a significant trend test on Day 1 (P=0.03) and Day 2 (P=0.02).
CONCLUSION
After reconstruction of isolated ACL tears with a hamstring graft, FNB is not more effective than LIA on patients' early postoperative pain. Patients who received a FNB consumed significantly less opioid-like analgesics.
LEVEL OF EVIDENCE
III - Prospective, comparative, non-randomized study.
引言
股神经阻滞（FNB）被认为是前交叉韧带（ACL）重建手术中的一项重大进展，因为它减少了胃肠外阿片类药物的使用需求。然而，膝关节手术后因股神经阻滞导致短暂甚至永久性神经功能缺损的发生率估计为1.94%。本研究的主要目的是比较ACL重建手术中局部浸润镇痛（LIA）与股神经阻滞的效果。研究假设是局部浸润镇痛在术后早期疼痛控制方面不比股神经阻滞效果差。
患者与方法
对前瞻性收集于FAST队列中的数据进行回顾性分析，纳入了2013 - 2014年接受自体腘绳肌腱移植单纯ACL一期修复的一系列连续患者。随着时间推移我们麻醉方式的改变使我们形成了三个连续的组：第1组 - 股神经阻滞组，第2组 - 股神经阻滞 + 局部浸润镇痛组，第3组 - 单纯局部浸润镇痛组。术前进行超声引导下股神经阻滞。局部浸润镇痛在手术结束时由外科医生完成，对所有皮肤切口和腘绳肌腱供区进行系统性浸润；未进行关节内注射。主要终点是患者在视觉模拟量表（0 - 10）上描述的术后早期平均疼痛程度（第0 - 3天）。样本量计算表明每组需要36名受试者进行非劣效性研究。
结果
该研究纳入126例患者：第1组 = 42例，第2组 = 38例，第3组 = 46例。患者入组时具有可比性。术后早期平均疼痛程度分别为3.1±2.4、2.8±2.0和2.5±2.2（P = 0.66）。在第0天至第3天，局部浸润镇痛组曲马多的摄入量有增加趋势，在第1天（P = 0.03）和第2天（P = 0.02）有显著趋势检验。
结论
自体腘绳肌腱移植重建单纯ACL撕裂后，股神经阻滞在患者术后早期疼痛控制方面并不比局部浸润镇痛更有效。接受股神经阻滞的患者阿片类镇痛药的消耗量显著更少。
证据水平
III - 前瞻性、比较性、非随机研究。
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