连续收肌管阻滞用于内侧单髁膝关节置换术后的镇痛：一项随机、双盲、安慰剂对照试验。
Continuous Adductor Canal Block used for postoperative pain relief after medial Unicondylar Knee Arthroplasty: a randomized, double-blind, placebo-controlled trial.
机构信息
Department of Anesthesiology Xuanwu Hospital, Capital Medical University, No.45, Changchun Street, Beijing, 100053, China.
Department of Anesthesiology, Peking University International Hospital, Beijing, China.
出版信息
BMC Anesthesiol. 2019 Jun 29;19(1):114. doi: 10.1186/s12871-019-0787-6.
BACKGROUND
Peripheral nerve block and local infiltration analgesia (LIA) provide good analgesia after knee replacement. This study evaluated the additional analgesic efficacy of continuous adductor canal block (ACB) added to single-dose LIA after medial unicondylar knee arthroplasty (UKA). We hypothesized ACB would lower pain scores and facilitate postoperative ambulation.
METHODS
Forty-six patients were enrolled into this double-blind, randomized, placebo-controlled trial. UKA was performed and all patients received single-dose LIA intraoperatively. Patients were randomized into two groups: Group RP receiving 0.2% ropivacaine or Group Con receiving normal saline. A flow at 6 mL/h was administered for 48 h through a catheter in the adductor canal. Primary outcome was movement pain score at 24 h using the numeric rating scale (NRS-11). Secondary outcomes included serial postoperative pain scores, rate of patients with NRS>3 at rest and movement within 24 and 48 h postoperatively, time to breakthrough pain, quadriceps motor strength, ambulated distance, catheter related infection and patient satisfaction.
RESULTS
Forty-two patients were analyzed. Pain scores with movement at 24 h postoperatively were significantly lower in Group RP than that in Group Con (3 vs. 5 NRS, P<0.001). Compared with Group Con, breakthrough pain occurred later in Group RP (18.5 vs 10.0 h, P = 0.002), serial pain scores at rest and with movement and rate of patients with NRS>3 with movement after surgery were significantly lower. Quadriceps motor strength was equivalent, however, ambulated distance on postoperative day 1 and 2 in Group Con was significant less (19.7 vs 37.3 m, P = 0.046; 33.4 vs 59.5 m, P = 0.002).
CONCLUSIONS
Continuous adductor canal block added to single-dose LIA offered better analgesia and facilitated ambulation without motor weakness after medial UKA.
TRIAL REGISTRATION
Clinical Trial Registration: ChiCTR-IOR-16008720 ; Registered 25 June 2016.
背景
外周神经阻滞和局部浸润镇痛（LIA）可提供膝关节置换术后良好的镇痛效果。本研究评估了内侧单髁膝关节置换术后（UKA）单次 LIA 中添加连续收肌管阻滞（ACB）的额外镇痛效果。我们假设 ACB 会降低疼痛评分并促进术后活动。
方法
本研究纳入了 46 名患者，采用双盲、随机、安慰剂对照试验。行 UKA 手术，所有患者术中接受单次 LIA。患者随机分为两组：RP 组给予 0.2%罗哌卡因，Con 组给予生理盐水。通过收肌管内的导管以 6ml/h 的流速输注 48 小时。主要结局是使用数字评分量表（NRS-11）在 24 小时时的运动疼痛评分。次要结局包括术后连续疼痛评分、术后 24 和 48 小时内休息和运动时 NRS>3 的患者比例、爆发痛出现时间、股四头肌运动力量、活动距离、导管相关感染和患者满意度。
结果
42 名患者纳入分析。术后 24 小时运动时疼痛评分在 RP 组明显低于 Con 组（3 分比 5 分，P<0.001）。与 Con 组相比，RP 组爆发痛出现时间较晚（18.5 小时比 10.0 小时，P=0.002），术后休息和运动时的连续疼痛评分以及运动时 NRS>3 的患者比例较低。股四头肌运动力量相当，但 Con 组术后第 1 天和第 2 天的活动距离明显减少（19.7 米比 37.3 米，P=0.046；33.4 米比 59.5 米，P=0.002）。
结论
在 UKA 术后单次 LIA 中添加连续收肌管阻滞可提供更好的镇痛效果，并促进活动，而不会导致股四头肌无力。
试验注册
临床试验注册：ChiCTR-IOR-16008720；注册日期：2016 年 6 月 25 日。
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