Ma Jinhui, Gao Fuqiang, Sun Wei, Guo Wanshou, Li Zirong, Wang Weiguo
Peking University China-Japan Friendship School of Clinical Medicine Center for Osteonecrosis and Joint Preserving and Reconstruction, Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Chaoyang District, Beijing, China.
Medicine (Baltimore). 2016 Dec;95(52):e5701. doi: 10.1097/MD.0000000000005701.
Both adductor canal block (ACB) and periarticular infiltration (PI) have been shown to reduce pain after total knee arthroplasty (TKA) without the motor blockade. However, the efficacy and safety of combined ACB with PI (ACB + PI) as compared to PI alone for analgesia after TKA remains controversial. We therefore performed a meta-analysis to compare the effects of ACB + PI with PI alone on pain controll after TKA.
PubMed, Medline, Embase, Web of Science, and the Cochrane Library were searched to identify studies comparing ACB + PI with PI alone for TKA patients. The primary outcomes included pain score with rest or activity and morphine consumption. Secondary outcomes were distance walked, length of hospital stay, and postoperative complications. Relevant data were analyzed using RevMan v5.3.
Three studies involving 337 patients were included. Combined ACB with PI was associated with longer distances walked than PI alone (MD = 7.27, 95% CI: 0.43-14.12, P = 0.04) on postoperative day 1. The outcomes of pain, morphine consumption, length of hospital stay, and postoperative complications were not statistically different between the 2 groups (P > 0.05).
Our meta-analysis suggests that combined ACB with PI may achieve earlier ambulation for patients after TKA without a reduction in analgesia when compared to PI alone in the early postoperative period. There were no significant differences in morphine consumption, length of hospital stay, and postoperative complications between the 2 groups. However, owing to the variation of included studies, no firm conclusions can be drawn.
内收肌管阻滞（ACB）和关节周围浸润（PI）均已被证明可减轻全膝关节置换术（TKA）后的疼痛，且不会导致运动阻滞。然而，与单纯PI相比，ACB联合PI（ACB+PI）用于TKA术后镇痛的疗效和安全性仍存在争议。因此，我们进行了一项荟萃分析，以比较ACB+PI与单纯PI对TKA术后疼痛控制的效果。
检索PubMed、Medline、Embase、Web of Science和Cochrane图书馆，以确定比较ACB+PI与单纯PI用于TKA患者的研究。主要结局包括休息或活动时的疼痛评分以及吗啡消耗量。次要结局为行走距离、住院时间和术后并发症。使用RevMan v5.3分析相关数据。
纳入了3项涉及337例患者的研究。术后第1天，ACB联合PI组的行走距离比单纯PI组长（MD=7.27，95%CI：0.43-14.12，P=0.04）。两组在疼痛、吗啡消耗量、住院时间和术后并发症方面的结局无统计学差异（P>0.05）。
我们的荟萃分析表明，与术后早期单纯PI相比，ACB联合PI可使TKA患者更早下地行走，且镇痛效果不降低。两组在吗啡消耗量、住院时间和术后并发症方面无显著差异。然而，由于纳入研究存在差异，无法得出确切结论。
