Department of Orthopaedic Surgery, Duke University, Durham, NC.
Department of Orthopaedic Surgery, Duke University, Durham, NC; Department of Orthopaedic Surgery, Durham VA Medical Center, Durham, NC.
J Arthroplasty. 2020 May;35(5):1233-1238. doi: 10.1016/j.arth.2020.01.030. Epub 2020 Jan 22.
Periarticular injection or anesthesiologist-performed adductor canal block are commonly used for pain management after total knee arthroplasty. A surgeon-performed, intra-articular saphenous nerve block has been recently described. There is insufficient data comparing the efficacy and safety of these methods.
This is a retrospective two-surgeon cohort study comparing short-term perioperative outcomes after primary total knee arthroplasty, in 50 consecutive patients with surgeon-performed high-dose periarticular injection and intra-articular saphenous nerve block (60 mL 0.5% bupivacaine, 30 mL saline, 30mg ketorolac) and 50 consecutive patients with anesthesiologist-performed adductor canal catheter (0.25% bupivacaine 6 mL/h infusion pump placed postoperatively with ultrasound guidance). Chart review assessed pain scores through POD #1, opioid use, length of stay, and short-term complications, including local anesthetic systemic toxicity. Statistical analysis was performed with two-tailed Student's T-test.
The high-dose periarticular injection cohort had significantly lower pain scores in the postanesthesia care unit (mean difference 1.4, P = .035), on arrival to the inpatient ward (mean difference 1.7, P = .013), and required less IV narcotics on the day of surgery (mean difference 6.5 MME, P = .0004). There was no significant difference in pain scores on POD #1, total opioid use, day of discharge, or short-term complications. There were no adverse events related to the high dose of bupivacaine.
Compared with postoperative adductor canal block catheter, an intraoperative high-dose periarticular block demonstrated lower pain scores and less IV narcotic use on the day of surgery. No difference was noted in pain scores on POD #1, time to discharge, or complications. There were no cardiovascular complications (local anesthetic systemic toxicity) despite the high dose of bupivacaine injected.
III.
关节周围注射或麻醉师施行的收肌管阻滞是全膝关节置换术后常用的止痛方法。最近有研究描述了一种由外科医生施行的关节内隐神经阻滞。目前关于这些方法的疗效和安全性的数据还不够充分。
这是一项回顾性的双外科医生队列研究，比较了 50 例连续接受外科医生施行的高剂量关节周围注射和关节内隐神经阻滞（60ml0.5%布比卡因，30ml 生理盐水，30mg 酮咯酸）与 50 例连续接受麻醉师施行的收肌管导管阻滞（0.25%布比卡因 6ml/h 输注泵，术后在超声引导下放置）的初次全膝关节置换术后短期围手术期结局。通过术后第 1 天（POD#1）、阿片类药物使用、住院时间和包括局部麻醉药全身毒性在内的短期并发症评估疼痛评分。采用双尾 Student's t 检验进行统计学分析。
高剂量关节周围注射组在麻醉后护理单元（平均差值 1.4，P=0.035）、到达住院病房时（平均差值 1.7，P=0.013）和手术当天需要的静脉阿片类药物更少（平均差值 6.5MME，P=0.0004）。在 POD#1、总阿片类药物使用、出院日或短期并发症方面，两组的疼痛评分无显著差异。未发生与大剂量布比卡因相关的不良事件。
与术后收肌管阻滞导管相比，术中高剂量关节周围阻滞可降低手术当天的疼痛评分和静脉阿片类药物使用量。POD#1 的疼痛评分、出院时间或并发症无差异。尽管注射了大剂量布比卡因，但未发生心血管并发症（局部麻醉药全身毒性）。
III 级。
