Koh Hyun J, Koh In J, Kim Man S, Choi Keun Y, Jo Hyeon U, In Yong
Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, Seoul, Korea; Department of Anesthesia and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, Seoul, Korea; Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.
J Arthroplasty. 2017 Jun;32(6):1856-1861. doi: 10.1016/j.arth.2017.01.025. Epub 2017 Jan 26.
Femoral nerve block (FNB) has been used as part of the multimodal analgesia after total knee arthroplasty (TKA), but leads to weakness in the quadriceps muscles. Recently, adductor canal block (ACB) was reported to provide effective pain relief while sparing the strength of the quadriceps. This simultaneous bilateral randomized study investigated whether patients perceived differences between ACB and the FNB after same-day bilateral TKA.
We performed a prospective simultaneous bilateral randomized study in 50 patients scheduled to undergo same-day bilateral TKA. One knee was randomly assigned to ACB and the other knee was assigned to FNB. All ACB and FNB were performed using ultrasound-guided single-shot procedures. These 2 groups were compared for pain visual analogue scale, straight leg raising ability and knee extension while sitting, and motor grade. At postoperative week 1, the peak torque for the quadriceps muscle was measured in both knees with an isokinetic dynamometer.
There were no differences in pain levels between ACB and FNB during the entire study period. During the first 48 h after TKA, more of the knees that received ACB could perform straight leg raising and knee extension with greater quadriceps strength compared with FNB. However, no group differences in quadriceps functional recovery were found after postoperative 48 h and isometric quadriceps strength at postoperative 1 week.
This simultaneous bilateral randomized study demonstrates that patients did not perceive differences in pain level, but experienced substantial differences in quadriceps strength recovery between knees during the first 48 h (Identifier: NCT02513082).
股神经阻滞（FNB）已被用作全膝关节置换术（TKA）后多模式镇痛的一部分，但会导致股四头肌无力。最近，有报道称收肌管阻滞（ACB）在缓解疼痛的同时能保留股四头肌的力量。这项同期双侧随机研究调查了在同日双侧TKA后患者是否能察觉到ACB和FNB之间的差异。
我们对50例计划同日进行双侧TKA的患者进行了一项前瞻性同期双侧随机研究。一侧膝关节随机分配接受ACB，另一侧膝关节分配接受FNB。所有ACB和FNB均采用超声引导单次注射操作。比较这两组在疼痛视觉模拟量表、直腿抬高能力、坐位时膝关节伸展以及运动分级方面的差异。在术后第1周，使用等速测力计测量双膝股四头肌的峰值扭矩。
在整个研究期间，ACB和FNB之间的疼痛水平没有差异。在TKA后的前48小时内，与FNB相比，接受ACB的膝关节更多地能够进行直腿抬高和膝关节伸展，且股四头肌力量更强。然而，在术后48小时后以及术后1周时股四头肌等长力量方面，未发现两组之间存在差异。
这项同期双侧随机研究表明，患者在疼痛水平上未察觉到差异，但在术后的前48小时内，双膝在股四头肌力量恢复方面存在显著差异（标识符：NCT02513082）。
