Li Canfeng, Xu Hongwei, Shen Bin, Yang Jing, Zhou Zongke, Kang Pengde, Pei Fuxing
Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China.
Department of Anesthesia, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 Sep 15;31(9):1049-1054. doi: 10.7507/1002-1892.201704056.
To compare the analgesia effect and clinical rehabilitation between continuous adductor canal block (ACB) and single shot ACB in total knee arthroplasty (TKA)．.
Between October 2016 and February 2017, 60 patients with severe knee osteoarthritis undergoing primary unilateral TKA were prospectively recruited in the study. All the patients were randomly allocated into 2 groups and received ultrasound-guided continuous ACB (group A, =30) or single shot ACB (group B, =30), respectively. There was no significant difference in gender, age, body mass index, nationality, American Society of Anesthesiology (ASA) grading, and preoperative knee range of motion and quadriceps strength between 2 groups ( >0.05). After operation, the tourniquet time, postoperative drainage volume, hospitalization time, and adverse events in 2 groups were recorded. Visual analogue scale (VAS) scores at rest and during activity, the quadriceps strength, the knee range of motion, and the time of 90° knee flexion in 2 groups were also recorded and compared.
There was no significant difference in tourniquet time, postoperative drainage volume, and incidence of adverse events between 2 groups ( >0.05). But the hospitalization time was significant shorter in group A than in group B ( <0.05). VAS scores at rest and during activity were lower in group A than in group B, with significant differences in VAS score at rest after 12 hours and in VAS score during activity after 8 hours between 2 groups ( <0.05). The quadriceps strength was higher in group A than in group B, with significant difference at 24, 48, and 72 hours ( <0.05). The knee range of motion was significantly better in group A than in group B at 24, 48, 72 hours and on discharge ( <0.05). The time of 90° knee flexion was significantly shorter in group A than in group B ( =-2.951, =0.016). There were 4 patients in group A and 7 patients in group B requiring meperidine hydrochloride (50 mg/time) within 24 hours, and 3 patients in group A and 7 patients in group B at 24 to 48 hours, and 1 patient in group A and 3 patients in group B at 48 to 72 hours. Effusion in the catheter site occurred in 2 cases of group A, but no catheter extrusion occurred.
Continuous ACB is superior in analgesia both at rest and during activity and opioid consumption compared with single shot ACB after TKA. And the quadriceps strength could be reserved better in continuous ACB group, which can perform benefits in early rehabilitation.
比较全膝关节置换术（TKA）中连续收肌管阻滞（ACB）与单次ACB的镇痛效果及临床康复情况。
2016年10月至2017年2月，前瞻性纳入60例接受初次单侧TKA的重度膝骨关节炎患者。所有患者随机分为2组，分别接受超声引导下连续ACB（A组，n = 30）或单次ACB（B组，n = 30）。两组在性别、年龄、体重指数、国籍、美国麻醉医师协会（ASA）分级以及术前膝关节活动范围和股四头肌力量方面无显著差异（P>0.05）。术后记录两组的止血带时间、术后引流量、住院时间及不良事件。还记录并比较两组静息和活动时的视觉模拟量表（VAS）评分、股四头肌力量、膝关节活动范围以及膝关节屈曲90°的时间。
两组在止血带时间、术后引流量及不良事件发生率方面无显著差异（P>0.05）。但A组住院时间显著短于B组（P<0.05）。A组静息和活动时的VAS评分均低于B组，两组在术后12小时静息VAS评分及术后8小时活动VAS评分方面有显著差异（P<0.05）。A组股四头肌力量高于B组，在术后24、48和72小时有显著差异（P<0.05）。在术后24、48、72小时及出院时，A组膝关节活动范围显著优于B组（P<0.05）。A组膝关节屈曲90°的时间显著短于B组（t = -2.951，P = 0.016）。A组有4例患者、B组有7例患者在24小时内需要盐酸哌替啶（50mg/次），A组有3例患者、B组有7例患者在24至48小时需要，A组有1例患者、B组有3例患者在48至72小时需要。A组有2例患者发生导管部位积液，但未发生导管挤出。
与TKA术后单次ACB相比，连续ACB在静息和活动时的镇痛及阿片类药物消耗方面更具优势。并且连续ACB组能更好地保留股四头肌力量，这对早期康复有益。
