Alsheikh Khalid A, Alkhelaifi Ahmed S, Alharbi Mohammed K, Alhabradi Faisal A, Alzahrani Faisal A, Alsalim Abdulrahman A, Alhandi Ali A, Aldosary Arwa K
College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Department of Orthopedics, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia.
Saudi J Anaesth. 2020 Jan-Mar;14(1):38-43. doi: 10.4103/sja.SJA_354_19. Epub 2020 Jan 6.
Total knee arthroplasty is associated with intense pain postoperatively. Thus, adequate pain relief is essential in the immediate postoperative period to enable ambulation, initiation of physiotherapy, and prevention of postoperative complications. The objective of this study was to compare the effectiveness and early outcomes of adductor canal blockade (ACB) and continuous epidural analgesia (CEA) in patients who underwent a unilateral total knee replacement (TKR).
This is a retrospective cohort study that was conducted in Riyadh with 80 patients receiving a unilateral total knee arthroplasty from August 2017 to July 2018. Forty patients received ACB, and 40 received CEA exclusively. The primary outcomes measured were the degree of knee flexion and extension in physiotherapy sessions on postoperative day 1 and discharge, how soon patients walked after surgery, length of hospital stay (LOS), local anesthetic and total opioid consumption, postoperative blood drainage output, incidence of nausea and vomiting, and pain scores.
Significantly more patients receiving ACB could flex their knee in the first 24 h postoperatively ( < 0.05), and the total drain output was also significantly less ( < 0.05). Pain in the first 8, 24, and 48 h was less in the ACB group using a Visual Analog Scale ( < 0.05). In addition, LOS, total opioid consumption, postoperative blood drain output, incidence of nausea and vomiting, and pain scores were significantly decreased after using ACB compared with epidural analgesia.
This study provided evidence that ACB as postoperative analgesia after TKR is associated with better outcomes in terms of facilitating early functional recovery and mobility, and consequently prevents major postoperative complications.
全膝关节置换术后会伴有剧烈疼痛。因此，术后即刻充分缓解疼痛对于患者能够行走、开始物理治疗以及预防术后并发症至关重要。本研究的目的是比较内收肌管阻滞（ACB）和连续硬膜外镇痛（CEA）在接受单侧全膝关节置换术（TKR）患者中的有效性和早期结局。
这是一项回顾性队列研究，在利雅得进行，纳入了2017年8月至2018年7月期间接受单侧全膝关节置换术的80例患者。40例患者仅接受ACB，40例患者仅接受CEA。主要测量的结局指标包括术后第1天和出院时物理治疗期间膝关节的屈伸程度、患者术后开始行走的时间、住院时间（LOS）、局部麻醉药和总阿片类药物消耗量、术后引流量、恶心和呕吐的发生率以及疼痛评分。
接受ACB的患者在术后24小时内能够屈曲膝关节的人数显著更多（<0.05），总引流量也显著更少（<0.05）。使用视觉模拟量表（VAS）评估，ACB组在术后最初8、24和48小时的疼痛程度更低（<0.05）。此外，与硬膜外镇痛相比，使用ACB后LOS、总阿片类药物消耗量、术后引流量、恶心和呕吐的发生率以及疼痛评分均显著降低。
本研究提供的证据表明，TKR术后使用ACB进行镇痛在促进早期功能恢复和活动能力方面具有更好的结局，从而预防了主要的术后并发症。
