Arora Suman, Sadashivappa Chethan, Sen Indu, Sahni Neeru, Gandhi Komal, Batra Y K, Dhillon M S
Postgraduate Institute of Medical Education and Research (PGIMER), Department of Anaesthesia & Intensive Care, Chandigarh, Índia.
Postgraduate Institute of Medical Education and Research (PGIMER), Department of Anaesthesia & Intensive Care, Chandigarh, Índia.
Braz J Anesthesiol. 2019 May-Jun;69(3):272-278. doi: 10.1016/j.bjan.2018.12.004. Epub 2019 May 10.
Inadequate pain relief after anterior cruciate ligament reconstruction affects mobility leading to development of adhesions, weakened ligament insertion and muscle atrophy. Adductor canal block for postoperative analgesia preserves quadriceps strength. The present study was conducted to compare pain free period in patients undergoing arthroscopic anterior cruciate ligament reconstruction, receiving ultrasound-guided adductor canal block with ropivacaine alone and ropivacaine with clonidine.
A prospective randomized double blinded study was conducted including sixty-three adult, ASA class I, II patients undergoing anterior cruciate ligament reconstruction. They were randomized into three groups: Group S – control group received adductor canal block with 30 mL saline, Group R – ropivacaine group received adductor canal block with 30 mL of 0.375% ropivacaine and Group RC – clonidine group received adductor canal block with 30 mL of 0.375% ropivacaine with clonidine 1 μg.kg. The primary aim was to compare the pain free period in patients receiving adductor canal block with ropivacaine alone or ropivacine with clonidine. The secondary outcomes were pain score at rest and movement, total analgesic requirement, sedation score and postoperative nausea and vomiting.
The mean pain free periods were 20 min, 384.76 min and 558.09 min for Group S, Group R and Group RC, respectively and this difference was statistically significant ( < 0.001). There was no significant difference between Group R and Group RC in terms of pain scores at rest and movement and total analgesic requirement.
Addition of clonidine to ropivacaine in USG guided adductor canal block led to significant prolongation of pain free period though pain score at rest and movement, and rescue analgesic requirement, did not differ.
前交叉韧带重建术后疼痛缓解不足会影响关节活动度,导致粘连形成、韧带附着点减弱和肌肉萎缩。内收肌管阻滞用于术后镇痛可保留股四头肌力量。本研究旨在比较接受关节镜下前交叉韧带重建的患者,单独接受超声引导下罗哌卡因内收肌管阻滞与罗哌卡因联合可乐定内收肌管阻滞的无痛期。
进行一项前瞻性随机双盲研究,纳入63例美国麻醉医师协会(ASA)分级为I、II级的成年患者,他们均接受前交叉韧带重建手术。将他们随机分为三组:S组(对照组)接受30 mL生理盐水内收肌管阻滞;R组(罗哌卡因组)接受30 mL 0.375%罗哌卡因内收肌管阻滞;RC组(可乐定组)接受30 mL含1 μg/kg可乐定的0.375%罗哌卡因内收肌管阻滞。主要目的是比较单独接受罗哌卡因内收肌管阻滞或罗哌卡因联合可乐定内收肌管阻滞患者的无痛期。次要结局指标为静息和活动时的疼痛评分、总镇痛药物需求量、镇静评分以及术后恶心呕吐情况。
S组、R组和RC组的平均无痛期分别为20分钟、384.76分钟和558.09分钟,差异具有统计学意义(P<0.001)。R组和RC组在静息和活动时的疼痛评分以及总镇痛药物需求量方面无显著差异。
在超声引导下内收肌管阻滞中,罗哌卡因联合可乐定可显著延长无痛期,尽管静息和活动时的疼痛评分以及补救性镇痛药物需求量并无差异。