Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, 185-1 Oko-cho Kohasu, Nankoku, 783-8505, Japan.
Department of Anaesthesiology, Kochi Medical School, Japan Kochi Medical School, Kochi University, 185-1 Oko-cho Kohasu, Nankoku, 783-8505, Japan.
Knee Surg Sports Traumatol Arthrosc. 2019 Jul;27(7):2368-2374. doi: 10.1007/s00167-018-5322-7. Epub 2018 Dec 8.
Multimodal analgesia has become an important concept in current pain management following total knee arthroplasty (TKA). However, controversy remains over what is the most accepted combination. In this study, the additional benefits of local infiltration of analgesia to femoral nerve block were evaluated.
Forty patients were randomly allocated into a combined local infiltration of analgesia and femoral nerve block or femoral nerve block alone group. In the former, analgesic drugs consisting of ropivacaine and dexamethasone were injected into the peri-articular tissues, while the same amount of saline was injected into the femoral nerve block group. The primary outcome measure was the total amount of fentanyl consumption by the patient-controlled analgesia pump during the 48-h post-operative period.
A combination of local infiltration of analgesia and femoral nerve block had less total fentanyl consumption and a larger knee ROM at post-operative day 2 than femoral nerve block alone (p < 0.05). C-reactive protein levels in the combined treatment group were significantly lower than the femoral nerve block group at post-operative day 3 (p < 0.01). There was no difference between the two groups, post-operatively, on the visual analogue scale for pain at rest or while walking, quadriceps strength, timed up and go test, circumference of thigh, Knee Society Score, and Western Ontario and McMaster Universities Osteoarthritis Index.
The addition of local infiltration of analgesia to femoral nerve block promoted post-operative pain relief and the recovery of knee ROM in the early post-operative period. This combination is an effective method for post-operative pain management after TKA.
Randomized controlled trial, Level I.
多模式镇痛已成为全膝关节置换术（TKA）后当前疼痛管理的重要概念。然而，对于最被接受的联合方案仍存在争议。本研究旨在评估股神经阻滞中局部浸润镇痛的额外益处。
40 名患者随机分为联合局部浸润镇痛和股神经阻滞组或股神经阻滞组。前者在关节周围组织中注射罗哌卡因和地塞米松等镇痛药物，而股神经阻滞组注射等量生理盐水。主要观察指标为术后 48 小时内患者自控镇痛泵的芬太尼总用量。
与股神经阻滞组相比，联合局部浸润镇痛和股神经阻滞组的总芬太尼用量更少，术后第 2 天膝关节活动度更大（p<0.05）。联合治疗组术后第 3 天 C 反应蛋白水平明显低于股神经阻滞组（p<0.01）。两组在术后静息和行走时的疼痛视觉模拟评分、股四头肌力量、计时起立行走测试、大腿周径、膝关节学会评分和西安大略和麦克马斯特大学骨关节炎指数方面均无差异。
股神经阻滞中局部浸润镇痛的应用促进了术后疼痛缓解和膝关节活动度的早期恢复。这种联合应用是 TKA 后术后疼痛管理的有效方法。
随机对照试验，I 级。
