Memorial Hermann's Ironman Sports Medicine Institute, Houston, Texas, U.S.A..
Department of Orthopedic Surgery, The University of Texas at Houston, Houston, Texas, U.S.A.
Arthroscopy. 2019 Mar;35(3):921-929. doi: 10.1016/j.arthro.2018.10.149. Epub 2019 Feb 4.
To compare femoral nerve blockade (FNB) versus adductor canal nerve blockade (ACB) for postoperative pain control and quadriceps muscle function in patients undergoing anterior cruciate ligament (ACL) reconstruction with patellar tendon autograft.
A randomized therapeutic trial of 90 patients undergoing ACL reconstruction with patellar tendon autograft was conducted comparing ACB versus FNB at 24 hours, 2 and 4 weeks, and 6 months postsurgery. Early outcome measures included average pain score and morphine equivalent units (milligrams) consumed, quadriceps surface electromyography, straight leg raise, and ability to ambulate without assistive devices. The 6-month outcome measures included knee range of motion (ROM), isokinetic knee extension peak torque, single-leg squat, and single-leg hop performance. Complications were recorded throughout the study for the development of anterior knee pain, knee extension ROM loss, deep vein thrombosis, and graft failure. Mixed-model analysis of variance and Mann-Whitney U tests were performed using an alpha of .05.
Quadriceps surface electromyography deficits were higher for FNB at 24 hours (P < .001) and 2 weeks (P < .001) when compared with the ACB group. There were no between-groups difference for subjective pain (P = .793) or morphine consumption (P = .358) within the first 24 hours of surgery. A higher percentage of patients in the ACB group met the full ambulation criteria at 4 weeks compared with the FNB group (100% vs 84.2%, P < .001). No between-group differences were observed at 6 months; however, the rate of knee extension ROM loss was higher for the FNB group versus the ACB group (21.1% vs 5.0%, P = .026), respectively.
ACB was as effective as FNB at providing pain control while eliciting fewer quadriceps muscle activation deficits and fewer postoperative complications. Based on previous evidence and the results of this study, we recommend the use of ACB over FNB for the analgesic management of patients undergoing ACL reconstruction with patellar tendon autograft.
Level I, prospective randomized controlled trial.
比较股神经阻滞（FNB）与收肌管神经阻滞（ACB）在接受髌腱自体移植前交叉韧带（ACL）重建术患者中的术后疼痛控制和股四头肌功能。
对 90 例行髌腱自体移植 ACL 重建术的患者进行了随机治疗试验，比较了 24 小时、2 周和 4 周以及术后 6 个月时的 ACB 与 FNB。早期结果指标包括平均疼痛评分和消耗的吗啡等效单位（毫克）、股四头肌表面肌电图、直腿抬高和无需辅助设备即可行走的能力。6 个月时的结果指标包括膝关节活动范围（ROM）、等速膝关节伸展峰值扭矩、单腿深蹲和单腿跳跃表现。记录整个研究过程中的并发症，包括前膝疼痛、膝关节伸展 ROM 丧失、深静脉血栓形成和移植物失败。采用 α 值为.05 的混合模型方差分析和 Mann-Whitney U 检验。
与 ACB 组相比，FNB 在 24 小时（P <.001）和 2 周（P <.001）时股四头肌表面肌电图的缺陷更高。在手术前 24 小时内，两组之间的主观疼痛（P =.793）或吗啡消耗（P =.358）无差异。在 4 周时，ACB 组中更多的患者符合完全步行标准，而 FNB 组为 84.2%（P <.001）。在 6 个月时没有观察到组间差异；然而，FNB 组的膝关节伸展 ROM 丧失率高于 ACB 组（21.1%对 5.0%，P =.026）。
ACB 在提供疼痛控制方面与 FNB 一样有效，同时引起的股四头肌激活缺陷和术后并发症更少。基于先前的证据和本研究的结果，我们建议在接受髌腱自体移植的 ACL 重建术患者中使用 ACB 而不是 FNB 进行镇痛管理。
一级，前瞻性随机对照试验。
