超声引导单次注射与连续坐骨神经阻滞对全膝关节置换术后疼痛管理和活动的影响（CoSinUS 试验）：一项随机、三盲对照试验。

Ultrasound-guided single injection versus continuous sciatic nerve blockade on pain management and mobilisation after total knee arthroplasty (CoSinUS trial): A randomised, triple-blinded controlled trial.

机构信息

From the Department of Anaesthesiology and Intensive Care Medicine, University Hospital Marburg (TW, IH, NS, HW, TS, CF), Centre for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Campus Marburg, Marburg (TH, TE, DE) and Department of Anaesthesiology and Intensive Care Medicine, Diakoniekrankenhaus Schwäbisch Hall, Schwäbisch Hall, Germany (TS).

出版信息

Eur J Anaesthesiol. 2018 Oct;35(10):782-791. doi: 10.1097/EJA.0000000000000830.

DOI:10.1097/EJA.0000000000000830

PMID:29794563

Abstract

BACKGROUND

Combining continuous femoral nerve blockade with single injection sciatic nerve blockade is standard peripheral nerve block practice for total knee arthroplasty (TKA) during the first 24 postoperative hours.

OBJECTIVES

To assess the analgesic benefits and mobilisation capability of continuous sciatic blockade in conjunction with continuous femoral nerve blockade for 72 h after arthroplasty.

DESIGN

Randomised, triple-blinded controlled trial.

SETTING

Single-Centre, German University Hospital.

PATIENTS

In total, 50 patients receiving continuous femoral nerve blockade (5 ml h ropivacaine 0.2%) for TKA under general anaesthesia.

INTERVENTIONS

Patients were randomised to receive a sciatic nerve catheter with an initial dose of 10 ml ropivacaine 0.2% followed by either continuous double-blinded application of 5 ml h ropivacaine 0.2% (CO) or 5 ml h saline infusion (SIN).

MAIN OUTCOME

Measures primary endpoint: cumulative morphine consumption until 48 h postoperatively. Further endpoints included morphine consumption, pain scores, mobilisation, dynamometry until postoperative day 3.

RESULTS

Median [25th to 75th percentiles] cumulative morphine consumption at postoperative day 2 differed significantly between groups (CO 15 mg [11 to 25] versus SIN, 43 mg [27 to 67.5, P < 0.0001) in the 48 patients in the final analysis. Overall pain scores were comparable at rest and during stress at each time point. However, significantly higher pain scores of the popliteal fossa were observed in the SIN group. Mobilisation was comparable between groups.

CONCLUSION

This trial demonstrates the superior analgesic effects of continuous sciatic nerve block compared with a single injection in combination with continuous femoral blockade during the first 72 h after TKA. However, mobilisation capability was impaired in both groups. Improved pain control from two catheters needs to be balanced against the potential risks of impaired mobilisation and patient falls.

TRIAL REGISTRATION

DRKS - German clinical trials register (no: DRKS00010152).

摘要

背景

在全膝关节置换术（TKA）后 24 小时内，将连续股神经阻滞与单次坐骨神经阻滞相结合是标准的周围神经阻滞实践。

目的

评估连续坐骨神经阻滞与连续股神经阻滞联合应用在关节置换后 72 小时内的镇痛效果和活动能力。

设计

随机、三盲对照试验。

设置

单中心、德国大学医院。

患者

总共 50 名接受全身麻醉下 TKA 连续股神经阻滞（5ml/h 罗哌卡因 0.2%）的患者。

干预

患者随机分为两组，一组接受坐骨神经导管，初始剂量为 10ml 罗哌卡因 0.2%，然后分别接受连续双盲应用 5ml/h 罗哌卡因 0.2%（CO）或 5ml/h 生理盐水输注（SIN）。

主要终点

累积吗啡消耗量直到术后 48 小时。进一步的终点包括吗啡消耗量、疼痛评分、术后第 3 天的活动能力和握力。

结果

在最终分析的 48 名患者中，术后第 2 天的累积吗啡消耗量中位数[25 至 75 百分位数]在 CO 组（15mg[11 至 25]）与 SIN 组（43mg[27 至 67.5，P<0.0001）之间有显著差异。在每个时间点，静息和活动时的总体疼痛评分相似。然而，SIN 组的腘窝疼痛评分明显更高。两组之间的活动能力相似。