Department of Anesthesiology and Intensive Care, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland.
Anaesthesiol Intensive Ther. 2020;52(2):126-131. doi: 10.5114/ait.2020.93710.
The best method of continuous femoral nerve block (CFNB) after total knee arthroplasty (TKA) has not been determined. The study aimed to assess the effectiveness of CFNB based on patient-controlled regional analgesia (PCRA) with basal infusion of local anesthetic in decreasing pain and providing functional restoration after TKA and to compare it with the method of basal infusion only.
The prospective randomized controlled trial included 90 patients who were divided into three groups. Group I: control group with basal morphine infusion, without CFNB. Group II: CFNB with continuous infusion of ropivacaine. Group III: CFNB with basal infusion of ropivacaine plus boluses. Intensity of pain, morphine consumption, patient satisfaction, adverse effects, the effect on range of motion (ROM) in the knee joint, as well as using the measure of a distance were analyzed.
A lower level of pain was observed (P < 0.005), as was reduced opioid consumption (P < 0.005), a greater ROM (P < 0.005), a longer distance covered (P < 0.005), and a smaller incidence of nausea in group III when compared with group II. No statistically significant difference was noted between the groups in terms of other side effects. There was higher satisfaction between group II and group III on days 1 and 2 (P < 0.08).
It was demonstrated that CFNB with continuous infusion of 5 mL h-1 of 0.2% ropivacaine plus 5 mL as a bolus causes a greater reduction in pain intensity and opioid consumption; it also shortens the time of functional restoration in comparison to perineural infusion of 5mL h-1 only during the first 4 days after TKA and constitutes an effective and safe alternative to using an electronic pump.
全膝关节置换术后（TKA）最佳的连续股神经阻滞（CFNB）方法尚未确定。本研究旨在评估基于局部麻醉药基础输注的患者自控区域镇痛（PCRA）的 CFNB 在降低 TKA 后疼痛和提供功能恢复方面的效果，并与仅基础输注的方法进行比较。
前瞻性随机对照试验纳入 90 例患者，分为三组。组 I：对照组，仅行基础吗啡输注，无 CFNB。组 II：CFNB 加连续输注罗哌卡因。组 III：CFNB 加基础输注罗哌卡因加推注。分析疼痛强度、吗啡消耗量、患者满意度、不良反应、对膝关节活动度（ROM）的影响以及使用距离测量。
与组 II 相比，组 III 疼痛程度较低（P<0.005），阿片类药物消耗减少（P<0.005），ROM 更大（P<0.005），行走距离更长（P<0.005），恶心发生率更低（P<0.005）。两组在其他不良反应方面无统计学差异。组 II 和组 III 在第 1 天和第 2 天的满意度更高（P<0.08）。
与仅行神经周围输注 5 mL h-1 0.2%罗哌卡因相比，CFNB 加 5 mL 推注可更大程度地降低疼痛强度和阿片类药物消耗；在 TKA 后前 4 天，它还能缩短功能恢复时间，是使用电子泵的有效且安全的替代方法。
