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连续收肌管阻滞优于单独收肌管阻滞或收肌管阻滞联合 IPACK 阻滞(腘动脉和膝关节后囊之间的间隙)在全膝关节置换术后的镇痛和活动:随机对照试验。

Continuous adductor canal block is superior to adductor canal block alone or adductor canal block combined with IPACK block (interspace between the popliteal artery and the posterior capsule of knee) in postoperative analgesia and ambulation following total knee arthroplasty: randomized control trial.

机构信息

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.

出版信息

Musculoskelet Surg. 2022 Jun;106(2):155-162. doi: 10.1007/s12306-020-00682-8. Epub 2020 Sep 27.


DOI:10.1007/s12306-020-00682-8
PMID:32980982
Abstract

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.

摘要

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。

相似文献

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Musculoskelet Surg. 2022-6

[2]
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[3]
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[4]
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[5]
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[9]
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引用本文的文献

[1]
Management of Postoperative Pain Following Primary Total Knee Arthroplasty: A Level I Evidence-Based Bayesian Network Meta-Analysis.

Pharmaceuticals (Basel). 2025-4-9

[2]
Effects of Genicular Nerve Blocks in Combination With an Adductor Canal Block in Patients Undergoing Arthroscopic Knee Surgery: A Randomized Controlled Trial.

Cureus. 2025-2-18

[3]
Analgesic Effect of Intermittent Multiple IPACK Block Combined with ACB in Patients with Flexion Contracture Knee Arthritis Undergoing Total Knee Arthroplasty.

J Knee Surg. 2025-5

[4]
Different peripheral nerve blocks for patients undergoing total knee arthroplasty: a network meta-analysis of randomized controlled trials.

Arch Orthop Trauma Surg. 2024-9

[5]
Comparing Different Multimodal Analgesia Protocols for Primary Total Knee Arthroplasty-A Retrospective Cohort Analysis.

J Clin Med. 2024-7-12

[6]
IPACK Block Efficacy for Acute Pain Management after Total Knee Replacement: A Review.

Curr Pain Headache Rep. 2024-7

[7]
Periarticular injection, iPACK block, and peripheral nerve block in pain management after total knee arthroplasty: a structured narrative review.

Perioper Med (Lond). 2023-11-15

[8]
Evaluation of Postoperative Analgesic Efficacy of Ultrasound-Guided Suprainguinal Fascia Iliaca Block in Knee Arthroplasty: Prospective, Randomized, Feasibility Study.

J Clin Med. 2023-9-20

[9]
Peripheral Nerve Catheter Reduces Postoperative Opioid Consumption and Pain in Revision Total Knee Arthroplasty.

Arthroplast Today. 2023-6-12

[10]
Clinical effects of interspace between the popliteal artery and capsule of the posterior knee block with multimodal analgesia for total knee arthroplasty: a systematic review and meta-analysis.

Arch Orthop Trauma Surg. 2023-9

本文引用的文献

[1]
Accuracy of modified 30-s chair-stand test for predicting falls in older adults.

Ann Phys Rehabil Med. 2020-7

[2]
Continuous Adductor Canal Block used for postoperative pain relief after medial Unicondylar Knee Arthroplasty: a randomized, double-blind, placebo-controlled trial.

BMC Anesthesiol. 2019-6-29

[3]
Comparative study of the influence of adductor canal block plus multimodal periarticular infiltration versus combined adductor canal block, multimodal periarticular infiltration and intra-articular epidural catheter ropivacaine infiltration on pain relief after total knee arthroplasty: a prospective study.

Musculoskelet Surg. 2020-8

[4]
A comparative study evaluating the role of adductor canal block catheter versus intraarticular analgesic infusion on knee pain and range of motion in the immediate postoperative period: a prospective multicenter trial.

Musculoskelet Surg. 2020-12

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A prospective randomized open-label study of single injection versus continuous adductor canal block for postoperative analgesia after total knee arthroplasty.

Bone Joint J. 2019-3

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Arthroplast Today. 2018-9-1

[7]
Addition of Infiltration Between the Popliteal Artery and the Capsule of the Posterior Knee and Adductor Canal Block to Periarticular Injection Enhances Postoperative Pain Control in Total Knee Arthroplasty: A Randomized Controlled Trial.

Anesth Analg. 2019-8

[8]
Case Report of a Massive Thigh Hematoma after Adductor Canal Block in a Morbidly Obese Woman Anticoagulated with Apixaban.

Case Rep Anesthesiol. 2018-8-13

[9]
A Randomized Non-Inferiority Trial of Adductor Canal Block for Analgesia After Total Knee Arthroplasty: Single Injection Versus Catheter Technique.

J Arthroplasty. 2017-11-16

[10]
Incidence of Local Anesthetic Systemic Toxicity in Orthopedic Patients Receiving Peripheral Nerve Blocks.

Reg Anesth Pain Med. 2017

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