Koh In Jun, Choi Young Jun, Kim Man Soo, Koh Hyun Jung, Kang Min Sung, In Yong
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.
Knee Surg Relat Res. 2017 Jun 1;29(2):87-95. doi: 10.5792/ksrr.16.039.
Inadequate pain management after total knee arthroplasty (TKA) impedes recovery, increases the risk of postoperative complications, and results in patient dissatisfaction. Although the preemptive use of multimodal measures is currently considered the principle of pain management after TKA, no gold standard pain management protocol has been established. Peripheral nerve blocks have been used as part of a contemporary multimodal approach to pain control after TKA. Femoral nerve block (FNB) has excellent postoperative analgesia and is now a commonly used analgesic modality for TKA pain control. However, FNB leads to quadriceps muscle weakness, which impairs early mobilization and increases the risk of postoperative falls. In this context, emerging evidence suggests that adductor canal block (ACB) facilitates postoperative rehabilitation compared with FNB because it primarily provides a sensory nerve block with sparing of quadriceps strength. However, whether ACB is more appropriate for contemporary pain management after TKA remains controversial. The objective of this study was to review and summarize recent studies regarding practical issues for ACB and comparisons of analgesic efficacy and functional recovery between ACB and FNB in patients who have undergone TKA.
全膝关节置换术（TKA）后疼痛管理不当会阻碍恢复、增加术后并发症风险并导致患者不满。尽管目前认为术前使用多模式措施是TKA后疼痛管理的原则，但尚未建立金标准的疼痛管理方案。周围神经阻滞已被用作TKA后当代多模式疼痛控制方法的一部分。股神经阻滞（FNB）具有出色的术后镇痛效果，现在是用于TKA疼痛控制的常用镇痛方式。然而，FNB会导致股四头肌无力，这会妨碍早期活动并增加术后跌倒的风险。在这种情况下，新出现的证据表明，与FNB相比，收肌管阻滞（ACB）更有利于术后康复，因为它主要提供感觉神经阻滞，同时保留股四头肌力量。然而，ACB是否更适合当代TKA后的疼痛管理仍存在争议。本研究的目的是回顾和总结近期关于ACB实际问题以及ACB与FNB在TKA患者中镇痛效果和功能恢复比较的研究。
