Department of Orthopaedics and Joint Replacement, Sunshine Hospital, Penderghast Road, Secunderabad, Telangana, 500003, India.
Department of Anesthesia and Perioperative Care, Sunshine Hospital, Penderghast Road, Secunderabad, Telangana, 500003, India.
Musculoskelet Surg. 2022 Jun;106(2):155-162. doi: 10.1007/s12306-020-00682-8. Epub 2020 Sep 27.
BACKGROUND: ACB is given as single injection or as continuous block or combined with IPACK block (interspace between the popliteal artery and the posterior capsule of knee) to reduce postoperative knee pain after total knee arthroplasty. The aim of this study is to evaluate the technique of ACB that is superior in controlling postoperative pain, decrease opioid consumption and facilitate ambulation in the immediate postoperative period. METHODS: A total of 171 patients were analyzed from a group of 180 patients who were randomized into three groups: (1) ACB alone, (2) continuous ACB infusion via catheter (CACB) and (3) ACB combined with IPACK. The primary outcome was pain at rest and after ambulation measured by VAS scale every 8 h till 48 h after surgery. The secondary outcome measures were opioid consumption in morphine equivalents, ambulation distance measured in feet on postoperative day 2, timed up and go test, 30 s chair stand test, sitting active extension lag test and maximal knee flexion at discharge. RESULTS: VAS score at rest and after ambulation, opioid consumption was significantly lower (p < 0.05%) in CACB group compared to other study groups. Similarly, patients in CACB showed significantly (p < 0.05%) better results in the secondary outcome measures. There were no significant differences in the outcomes between ACB and ACB combined with IPACK. CONCLUSION: CACB allows better pain control and less opioid consumption in the immediate postoperative period after TKA compared to ACB alone or ACB with IPACK resulting in better ambulation and rehabilitation. Clinical Trial Registration Number CTRI/2019/03/018239 registered on March 25, 2019.
背景:ACB 可作为单次注射、连续阻滞或与 IPACK 阻滞(腘动脉与膝关节后囊之间的间隙)联合使用,以减少全膝关节置换术后的膝关节疼痛。本研究旨在评估 ACB 技术,该技术在控制术后疼痛、减少阿片类药物消耗和促进术后早期活动方面具有优势。
方法:对 180 名随机分为三组的患者中的 171 名进行分析:(1)ACB 单独使用,(2)通过导管进行连续 ACB 输注(CACB),(3)ACB 联合 IPACK。主要结局是术后 48 小时内每 8 小时通过视觉模拟量表(VAS)评估静息和活动后的疼痛。次要结局测量指标为吗啡等效阿片类药物消耗量、术后第 2 天的步行距离(英尺)、计时起立行走测试、30 秒椅子站立测试、坐姿主动伸展滞后测试和出院时最大膝关节屈曲度。
结果:与其他研究组相比,CACB 组静息和活动后 VAS 评分、阿片类药物消耗量显著降低(p<0.05%)。同样,CACB 组在次要结局测量指标上表现出显著(p<0.05%)更好的结果。ACB 与 ACB 联合 IPACK 之间在结果上没有显著差异。
结论:与 ACB 单独使用或 ACB 联合 IPACK 相比,CACB 可在 TKA 后即刻获得更好的疼痛控制和更少的阿片类药物消耗,从而实现更好的活动和康复。临床试验注册号 CTRI/2019/03/018239 于 2019 年 3 月 25 日注册。
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