Grant Alexander E, Schwenk Eric S, Torjman Marc C, Hillesheim Richard, Chen Antonia F
Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Anesth Pain Med. 2017 Apr 17;7(3):e46695. doi: 10.5812/aapm.46695. eCollection 2017 Jun.
Multimodal analgesia featuring peripheral nerve blocks decreases postoperative pain for patients undergoing primary total knee arthroplasty (TKA). Many anesthesiologists and surgeons advocate for the use of adductor canal blocks (ACBs) for analgesia, which result in less weakness compared to femoral nerve blocks. Few data exist to guide analgesic management in total knee revision (TKR), considered to be more painful than primary TKA. We hypothesized that TKR patients with a continuous ACB would use more opioids than primary TKA patients who received the same analgesic regimen.
A retrospective study of 58 TKA and TKR patients who received ACBs in a multimodal protocol was conducted from 1/2014 to 3/2016. Exclusion criteria included patients who took ≥ 20 mg of morphine daily preoperatively. The primary outcome was 48-hour opioid consumption. Secondary outcomes included pain ratings, catheter boluses, and catheter infusion rate changes over 48 hours.
For the primary outcome of 48-hour opioid consumption, there was no significant difference between groups. Postoperative pain ratings were not significantly different during the overall 48-hour time period. There were also no significant differences in catheter boluses and infusion rate changes. Least squares regression analysis revealed a positive correlation between number of previous knee surgeries and postoperative pain level.
Patients who underwent TKR with continuous ACB experienced a similar postoperative analgesic course as primary TKA patients. Within the TKR cohort, the number of previous revisions was positively associated with pain level. Larger prospective studies with TKR are needed to confirm these findings.
以周围神经阻滞为特征的多模式镇痛可减轻初次全膝关节置换术（TKA）患者的术后疼痛。许多麻醉医师和外科医生提倡使用内收肌管阻滞（ACB）进行镇痛，与股神经阻滞相比，其导致的肌无力较轻。在全膝关节翻修术（TKR）中，可供指导镇痛管理的数据很少，而TKR被认为比初次TKA更疼痛。我们假设接受持续ACB的TKR患者比接受相同镇痛方案的初次TKA患者使用更多的阿片类药物。
对2014年1月至2016年3月期间接受多模式方案ACB的58例TKA和TKR患者进行回顾性研究。排除标准包括术前每日服用≥20mg吗啡的患者。主要结局是48小时阿片类药物消耗量。次要结局包括疼痛评分、导管推注量以及48小时内导管输注速率的变化。
对于48小时阿片类药物消耗量这一主要结局，两组之间无显著差异。在整个48小时期间，术后疼痛评分无显著差异。导管推注量和输注速率变化也无显著差异。最小二乘回归分析显示，既往膝关节手术次数与术后疼痛程度呈正相关。
接受持续ACB的TKR患者术后镇痛过程与初次TKA患者相似。在TKR队列中，既往翻修次数与疼痛程度呈正相关。需要对TKR进行更大规模的前瞻性研究来证实这些发现。
