Zuo Wei, Guo Wanshou, Ma Jinhui, Cui Wei
Peking University China-Japan Friendship School of Clinical Medicine, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China.
Center for Osteonecrosis and Joint Preserving & Reconstruction, Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China.
J Orthop Surg Res. 2019 Apr 11;14(1):101. doi: 10.1186/s13018-019-1138-5.
Both adductor canal block (ACB) and local infiltration analgesia (LIA) are effective procedures for postoperative pain control in total knee arthroplasty (TKA) without motor blockade. However, whether ACB combined with LIA has synergistic effect than ACB alone remains unknown. We hypothesized that ACB combined with LIA would have better postoperative pain control, less rescue opioid consumption and faster rehabilitation than ACB alone, without higher adverse event rate.
We conducted a meta-analysis to identify relevant articles involving ACB + LIA and ACB alone in patients who underwent TKA from online register databases such as PubMed, Medline, Embase, Web of Science, and the Cochrane Library. The primary outcomes were visual analog scale (VAS) score and morphine consumption. Secondary outcomes were postoperative range of motion (ROM) and adverse event rate.
According to the keyword search from online register databases, a total of 879 articles were identified, of which six articles that met the inclusion criteria were determined as eligible. There were three randomized controlled trials (RCTs) and three non-randomized prospective studies. As compared to the ACB alone group, the ACB + LIA group had lower VAS at rest on postoperative day 0 and 1, as well as significantly less morphine consumption on postoperative day 0 and 1 and significantly better postoperative ROM. There were no significant differences in adverse event rate.
As compared to ACB alone, ACB + LIA provides better analgesia and faster functional rehabilitation in patients who underwent TKA.
内收肌管阻滞（ACB）和局部浸润镇痛（LIA）都是全膝关节置换术（TKA）中有效的术后疼痛控制方法，且不会导致运动阻滞。然而，ACB联合LIA是否比单独使用ACB具有协同作用仍不清楚。我们假设，与单独使用ACB相比，ACB联合LIA在TKA患者中能提供更好的术后疼痛控制、更少的补救性阿片类药物消耗以及更快的康复，且不良事件发生率不会更高。
我们进行了一项荟萃分析，以从在线注册数据库（如PubMed、Medline、Embase、Web of Science和Cochrane图书馆）中识别涉及接受TKA的患者使用ACB联合LIA和单独使用ACB的相关文章。主要结局指标为视觉模拟量表（VAS）评分和吗啡消耗量。次要结局指标为术后活动范围（ROM）和不良事件发生率。
根据在线注册数据库的关键词搜索，共识别出879篇文章，其中6篇符合纳入标准的文章被确定为合格。有3项随机对照试验（RCT）和3项非随机前瞻性研究。与单独使用ACB组相比，ACB联合LIA组在术后第0天和第1天静息时的VAS较低，且在术后第0天和第1天的吗啡消耗量显著更少，术后ROM也显著更好。不良事件发生率无显著差异。
与单独使用ACB相比，ACB联合LIA在接受TKA的患者中能提供更好的镇痛效果和更快的功能康复。
