Chen Chang-Hwa Mary, Yun Andrew G, Fan Teresa
Department of Surgery, St. John's Health Center, Santa Monica, California.
Department of Pharmacy, St. John's Health Center, Santa Monica, California.
J Knee Surg. 2022 Jan;35(1):96-103. doi: 10.1055/s-0040-1713114. Epub 2020 Jun 24.
Adductor canal block (ACB) is advantageous for postoperative analgesia in total knee arthroplasty (TKA) because it results in minimal motor block. Liposomal bupivacaine (LB) is Food and Drug Administration-approved extended-release formulation of bupivacaine for interscalene peripheral nerve blocks. Its use is increasing in the TKA setting, mainly as a local infiltration agent. We compared the efficacy of ACB using LB versus ropivacaine in TKA. Two cohorts of patients were retrospectively analyzed at a single institution receiving ropivacaine and LB ACB for TKA. Duration of LB ACB, time to first opioid use postrecovery room, amount of opioid use postrecovery room, length of stay (LOS), and average and highest pain scores were collected. A total of 91 and 142 TKA patients received ropivacaine and LB for ACB, respectively. At 8 hours postrecovery room, more patients in the LB group required no opioids compared with the ropivacaine group ( = 0.026). Mean opioid consumption was lower in the LB group than in the ropivacaine group at 8 and 24 hours postrecovery room, although statistical significance was only observed at 8 hours ( = 0.022). The highest pain score for patients in the two groups was not statistically different. The average pain score for patients with a 2-day LOS was higher in the LB group, but average pain scores were similar for patients with 1- and 3-day LOS. Median LOS for the LB and ropivacaine groups was 1 and 2 days, respectively ( < 0.0001). Significantly lower opioid use at 8 hours postrecovery room was seen in the LB group compared with the ropivacaine group. There was no difference in opioid use at 24 and 48 hours. There was also no advantage with LB ACB in decreasing pain scores. However, the LB ACB group demonstrated a significantly shorter LOS compared with the ropivacaine ACB group.
内收肌管阻滞（ACB）在全膝关节置换术（TKA）中对术后镇痛具有优势，因为它导致的运动阻滞最小。脂质体布比卡因（LB）是美国食品药品监督管理局批准的用于肌间沟周围神经阻滞的布比卡因缓释制剂。它在TKA环境中的使用正在增加，主要作为局部浸润剂。我们比较了在TKA中使用LB与罗哌卡因进行ACB的疗效。在单一机构对接受罗哌卡因和LB ACB进行TKA的两组患者进行了回顾性分析。收集了LB ACB的持续时间、恢复室后首次使用阿片类药物的时间、恢复室后阿片类药物的使用量、住院时间（LOS）以及平均和最高疼痛评分。分别有91例和142例TKA患者接受了罗哌卡因和LB用于ACB。在恢复室后8小时，与罗哌卡因组相比，LB组中更多患者不需要使用阿片类药物（P = 0.026）。在恢复室后8小时和24小时，LB组的平均阿片类药物消耗量低于罗哌卡因组，尽管仅在8小时观察到统计学显著性（P = 0.022）。两组患者的最高疼痛评分无统计学差异。住院2天的患者中，LB组的平均疼痛评分较高，但住院1天和3天的患者平均疼痛评分相似。LB组和罗哌卡因组的中位住院时间分别为1天和2天（P < 0.0001）。与罗哌卡因组相比，LB组在恢复室后8小时的阿片类药物使用显著减少。在24小时和48小时时阿片类药物使用无差异。LB ACB在降低疼痛评分方面也没有优势。然而，与罗哌卡因ACB组相比，LB ACB组的住院时间显著缩短。
