Ascension Crittenton Hospital, 1101 W. University Rd, Rochester, MI, 48307, USA.
Premier Orthopaedics, 2004 Sproul Road, Broomall, PA, 19008, USA.
Knee Surg Sports Traumatol Arthrosc. 2019 Mar;27(3):822-826. doi: 10.1007/s00167-018-5111-3. Epub 2018 Aug 27.
Alternative modalities to optimize pain control after anterior cruciate ligament reconstruction (ACLR) are continually being explored. The purpose of this study was to compare femoral nerve block (FNB) only vs FNB with posterior capsule injection (PCI) of the knee for pain control in patients undergoing ACLR.
Patients undergoing primary ACLR were randomized to receive either FNB only or FNB with PCI. Following surgery, patient's pain was evaluated in the postoperative care unit (PACU) and at home for 4 days. Pain levels were measured via visual analog scale (VAS) and calculating opioid consumption. Outcomes of interest included postoperative pain levels and opioid consumption.
A total of 42 patients were evaluated, with 21 patients randomized to each study arm. Outcomes showed significant pain reduction in both anterior and posterior knee VAS scores in the PACU in those that received PCI (anterior VAS: 39.6 vs 21.3 (SD = 12.9), p < 0.01; posterior VAS: 25.4 vs 15.3 (SD = 8.05), p = 0.01). Moreover, the PCI group also showed significantly less opioid consumption compared to FNB only (23.5 vs 17.4 pills, p = 0.03). There were no differences found in pain scores between groups in home VAS sores.
These finding suggest the use of arthroscopically assisted injection of local anesthetic to the posterior capsule of the knee significantly reduces early post-operative pain and dramatically reduces the number of opoid medication taken after ACLR.
Prospective, randomized, control trial, Level I.
不断探索优化前交叉韧带重建（ACLR）后疼痛控制的替代方法。本研究的目的是比较单纯股神经阻滞（FNB）与膝关节后囊注射（PCI）对接受 ACLR 患者的疼痛控制效果。
接受初次 ACLR 的患者被随机分为仅接受 FNB 或 FNB 加 PCI 治疗。手术后，在术后护理单元（PACU）和术后 4 天在家中对患者的疼痛进行评估。通过视觉模拟评分（VAS）和计算阿片类药物消耗量来评估疼痛程度。主要观察指标包括术后疼痛程度和阿片类药物消耗量。
共评估了 42 例患者，其中 21 例随机分为每组。结果显示，PCI 组在 PACU 中前膝 VAS 评分（39.6 比 21.3（SD=12.9），p<0.01）和后膝 VAS 评分（25.4 比 15.3（SD=8.05），p=0.01）显著降低。此外，PCI 组与仅接受 FNB 组相比，阿片类药物消耗量也明显减少（23.5 比 17.4 片，p=0.03）。两组在家中 VAS 评分的疼痛评分无差异。
这些发现表明，关节镜辅助膝关节后囊注射局部麻醉可显著减轻术后早期疼痛，并显著减少 ACLR 后阿片类药物的使用量。
前瞻性、随机、对照试验，Ⅰ级。
