Gwam Chukwuweike U, Mistry Jaydev B, Khlopas Anton, Chughtai Morad, Thomas Melbin, Mont Michael A, Delanois Ronald E
Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland.
Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
J Arthroplasty. 2017 May;32(5):1470-1473. doi: 10.1016/j.arth.2016.11.049. Epub 2016 Dec 14.
Postoperative pain after total knee arthroplasty (TKA) can be burdensome. Multiple methods of pain control have been used, including adductor canal block (ACB) and multimodal periarticular analgesia (MPA). These two techniques have been studied have proven to be efficacious separately. The purpose of this study was to compare: (1) lengths of stay (LOS), (2) pain level, (3) discharge status, and (4) opioid use in TKA patients who received ACB alone vs patients who received ACB and MPA.
A single surgeon database was reviewed for patients who had a TKA between January 2015 and April 2016. Patients who received ACB with or without MPA were included. This yielded 127 patients who had a mean age of 63 years. Patients were grouped into having received ACB alone (n = 52) and having received ACB and MPA (n = 75). Patient records were reviewed to obtain demographic and end point data (LOS, pain, discharge status, and opioid use). Student t test and chi-squared test were used to compare continuous and categorical variables respectively.
There were no significant difference in mean LOS (P = .934), pain level (P = .142), discharge status (P = .077), or total opioid use (P = .708) between the 2 groups.
There was no significant difference in LOS, pain levels, discharge status, and opiate requirements between the 2 groups. ACB alone may be as effective as combined ACB and MPA in TKA patients for postoperative pain control. Larger prospective studies are needed to verify these findings and to improve generalization.
全膝关节置换术（TKA）后的术后疼痛可能很严重。已经使用了多种疼痛控制方法，包括股内收肌管阻滞（ACB）和多模式关节周围镇痛（MPA）。这两种技术已分别被研究证明是有效的。本研究的目的是比较：（1）住院时间（LOS），（2）疼痛程度，（3）出院状态，以及（4）接受单纯ACB的TKA患者与接受ACB和MPA的患者的阿片类药物使用情况。
回顾了一位外科医生的数据库中2015年1月至2016年4月期间接受TKA的患者。纳入接受ACB加或不加MPA的患者。这产生了127名平均年龄为63岁的患者。患者被分为单纯接受ACB组（n = 52）和接受ACB和MPA组（n = 75）。审查患者记录以获取人口统计学和终点数据（住院时间、疼痛、出院状态和阿片类药物使用情况）。分别使用学生t检验和卡方检验来比较连续变量和分类变量。
两组之间的平均住院时间（P = .934）、疼痛程度（P = .142）、出院状态（P = .077）或阿片类药物总使用量（P = .708）没有显著差异。
两组之间在住院时间、疼痛程度、出院状态和阿片类药物需求方面没有显著差异。在TKA患者中，单纯ACB在术后疼痛控制方面可能与ACB和MPA联合使用一样有效。需要更大规模的前瞻性研究来验证这些发现并提高普遍性。
