Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya City, Hyogo, Japan.
Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, Mito City, Ibaraki, Japan.
Arthroscopy. 2018 Jan;34(1):182-188. doi: 10.1016/j.arthro.2017.08.307. Epub 2017 Dec 6.
To compare the effectiveness and safety of periarticular injection (PI) with those of femoral nerve block (FNB) after anterior cruciate ligament (ACL) reconstruction.
A total of 129 patients scheduled for ACL reconstruction were randomly assigned to receive PI or FNB. Other perioperative interventions were identical for all patients. The primary outcome was the postoperative pain score 24 hours after surgery, which was measured using a 100-mm visual analog scale (VAS). The pain scores were also assessed to determine whether the VAS score would reach the threshold values reported for the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS).
The PI group had significantly lower VAS scores 24 hours after ACL reconstruction than the FNB group (21 mm vs 39 mm; P < .0001). Consequently, the primary outcome reached the level of clinical significance as indicated by the threshold values of an MCID of 9.9 and a PASS of 33. The PI group also had a significantly lower VAS score at rest at 4 hours, 8 hours, and 2 days after surgery (30 mm vs 39 mm [P = .025], 25 mm vs 33 mm [P = .022], and 22 mm vs 32 mm [P = .0022], respectively). The opioid consumption during the initial 24 hours was significantly lower in the PI group (354 μg vs 503 μg; P = .0003). The complication rate, including opioid-related complications, was not significantly different between groups.
The patients treated with PI had significantly better pain scores and lower opioid consumption than those treated with FNB without elevating the complication rate.
Level I, randomized controlled trial.
比较关节周围注射（PI）与股神经阻滞（FNB）在 ACL 重建后的疗效和安全性。
共 129 例行 ACL 重建的患者被随机分配接受 PI 或 FNB。所有患者均接受相同的围手术期干预措施。主要结局是术后 24 小时的术后疼痛评分，采用 100mm 视觉模拟评分（VAS）进行评估。还评估了疼痛评分，以确定 VAS 评分是否达到了最小临床重要差异（MCID）和可接受的症状状态（PASS）的阈值。
与 FNB 组相比，PI 组术后 24 小时 VAS 评分显著降低（21mm 比 39mm；P<.0001）。因此，主要结局达到了 MCID 为 9.9 和 PASS 为 33 的临床意义阈值。PI 组在术后 4 小时、8 小时和 2 天静息时的 VAS 评分也显著降低（30mm 比 39mm [P=.025]，25mm 比 33mm [P=.022]，22mm 比 32mm [P=.0022]）。PI 组在最初 24 小时内的阿片类药物消耗量也显著降低（354μg 比 503μg；P=.0003）。两组的并发症发生率，包括阿片类药物相关并发症，无显著差异。
与 FNB 相比，PI 治疗的患者疼痛评分明显更好，阿片类药物消耗更少，而不会增加并发症发生率。
I 级，随机对照试验。
