Masaracchia M M, Herrick M D, Barrington M J, Hartmann P R, Sites B D
Department of Anesthesiology and Pain Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Department of Anesthesia and Acute Pain Medicine, St. Vincent's Hospital, Melbourne, Melbourne Medical School, University of Melbourne, Melbourne, Australia.
Acta Anaesthesiol Scand. 2017 Feb;61(2):224-231. doi: 10.1111/aas.12845. Epub 2016 Dec 26.
Femoral nerve blocks have been the gold standard approach for post-operative analgesia following total knee arthroplasty; however, the adductor canal block has recently gained popularity due to less block-induced motor weakness. The primary aim of this time-series analysis was to identify whether regional anesthesia practice changes have occurred for total knee arthroplasty. Our secondary aim was to assess for possible associated changes in safety and quality.
Using a 20-member clinical registry, we examined the practice patterns and safety around the performance of adductor canal blocks for all total knee arthroplasties between 18 July 2011 to 9 October 2015. To obtain more information about changes in quality associated with this practice transition, we analyzed clinical outcomes data surrounding all primary total knee arthroplasties from the largest contributing institution.
A total of 6921 blocks were performed for 4822 primary and revision total knee arthroplasties (TKAs). Across the registry, adductor canal block utilization for TKA increased. This was not associated with any increase in immediate or recovery room-related complications. When analyzing unilateral primary TKAs from the largest surgical volume center (n = 766), there were no statistically significant changes in numeric rating scale scores (5.4 to 4.6, P value = 0.004), length of stay (3.0 to 2.8 days, P value = 0.3), or 30-day hospital re-evaluations for pain (2.8-4.9%, P value = 0.1).
There was a large increase in the utilization of adductor canal blockade for TKAs among participating registry members. This change in practice was not associated with significant changes in safety or quality.
股神经阻滞一直是全膝关节置换术后镇痛的金标准方法；然而，由于阻滞引起的运动无力较轻，内收肌管阻滞最近受到了欢迎。本次时间序列分析的主要目的是确定全膝关节置换术的区域麻醉实践是否发生了变化。我们的次要目的是评估安全性和质量方面可能的相关变化。
我们使用一个由20名成员组成的临床登记系统，研究了2011年7月18日至2015年10月9日期间所有全膝关节置换术中内收肌管阻滞的操作模式和安全性。为了获得更多关于这种实践转变相关质量变化的信息，我们分析了最大贡献机构所有初次全膝关节置换术的临床结局数据。
共对4822例初次和翻修全膝关节置换术（TKA）进行了6921次阻滞。在整个登记系统中，TKA的内收肌管阻滞使用率有所增加。这与即刻或恢复室相关并发症的任何增加均无关。当分析手术量最大中心的单侧初次TKA（n = 766）时，数字评分量表评分（5.4至4.6，P值 = 0.004）、住院时间（3.0至2.8天，P值 = 0.3）或30天医院疼痛再评估（2.8 - 4.9%，P值 = 0.1）均无统计学显著变化。
参与登记系统的成员中，TKA的内收肌管阻滞使用率大幅增加。这种实践变化与安全性或质量的显著变化无关。
