Department of Anesthesiology, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina.
J Arthroplasty. 2018 Oct;33(10):3160-3166.e1. doi: 10.1016/j.arth.2018.05.026. Epub 2018 May 24.
Peripheral nerve blockade is used to provide analgesia for patients undergoing total knee arthroplasty. This study compared a single-injection adductor canal block (SACB) with adjuvants to continuous adductor canal blockade (CACB). The hypothesis was that the 2 groups would have equivalent analgesia at 30 hours after neural blockade.
This was a double-blinded, randomized, controlled, equivalency trial. Sixty patients were randomized to either the SACB group (20 mL of 0.25% bupivacaine, 1.67 mcg/mL of clonidine, 2 mg of dexamethasone, 150 mcg of buprenorphine, and 2.5 mcg/mL of epinephrine) or the CACB group (20 mL 0.25% of bupivacaine injection with 2.5 mcg/mL of epinephrine followed by an 8 mL/h infusion of 0.125% bupivacaine continued through postoperative day 2). The primary outcome was movement pain scores at 30 hours using the numeric rating scale (NRS). The secondary outcomes included serial postoperative NRS pain scores (rest and movement every 6 hours), opioid consumption, time to first opioid administration, ability to straight leg raise, patient satisfaction, length of stay, and the incidence of nausea/vomiting.
An intention-to-treat analysis included 59 patients. The NRS pain scores with movement were equivalent at 30 hours (SACB 5.5 ± 2.8 vs CACB 5.7 ± 2.9 [mean NRS ± standard deviation]; mean difference 0.2 [-1.5 to 1.0 {90% confidence interval}]). All NRS pain scores were equivalent until 42 hours (rest) and 48 hours (rest and movement) with the CACB group having lower pain scores. Other secondary outcomes were not statistically different.
An SACB provides equivalent analgesia for up to 36 hours after block placement when compared with a CACB for patients undergoing total knee arthroplasty, though a CACB was favored at 42 hours and beyond.
外周神经阻滞被用于为接受全膝关节置换术的患者提供镇痛。本研究比较了单次股神经鞘内注射阻滞（SACB）加辅助药物与连续股神经鞘内阻滞（CACB）。假设两组在神经阻滞后 30 小时的镇痛效果相当。
这是一项双盲、随机、对照、等效性试验。将 60 名患者随机分为 SACB 组（20 mL 0.25%布比卡因，1.67 mcg/mL 可乐定，2 mg 地塞米松，150 mcg 丁丙诺啡和 2.5 mcg/mL 肾上腺素）或 CACB 组（20 mL 0.25%布比卡因注射，加 2.5 mcg/mL 肾上腺素，随后通过术后第 2 天输注 0.125%布比卡因 8 mL/h）。主要结局是使用数字评分量表（NRS）在 30 小时时的运动疼痛评分。次要结局包括术后连续 NRS 疼痛评分（休息和运动时每 6 小时一次）、阿片类药物消耗量、首次使用阿片类药物的时间、直腿抬高能力、患者满意度、住院时间和恶心/呕吐的发生率。
意向治疗分析包括 59 例患者。30 小时时运动时的 NRS 疼痛评分相当（SACB 5.5 ± 2.8 与 CACB 5.7 ± 2.9 [均数 NRS ±标准差]；平均差值 0.2[-1.5 至 1.0{90%置信区间}）。直到 42 小时（休息时）和 48 小时（休息和运动时），CACB 组的疼痛评分较低，所有 NRS 疼痛评分都相当。其他次要结局无统计学差异。
与连续股神经鞘内阻滞相比，单次股神经鞘内注射阻滞在阻滞后 36 小时内提供等效的镇痛效果，尽管在 42 小时及以后，连续股神经鞘内阻滞更为有利。
