Hospital Clínico Universidad de Chile, Department of Anesthesiology and Perioperative Medicine, University of Chile, Office B222 2nd Floor, Sector B, 999 Santos Dumont, Independencia, Santiago 8380456, Chile.
Hospital Clínico Universidad de Chile, Department of Anesthesiology and Perioperative Medicine, University of Chile, Office B222 2nd Floor, Sector B, 999 Santos Dumont, Independencia, Santiago 8380456, Chile.
J Clin Anesth. 2021 Feb;68:110076. doi: 10.1016/j.jclinane.2020.110076. Epub 2020 Oct 6.
This scoping review investigates the optimal combination of motor-sparing analgesic interventions for patients undergoing total knee replacement (TKR).
Scoping review.
MEDLINE, EMBASE and CINAHL databases were searched (inception-last week of May 2020). Only trials including motor-sparing interventions were included. Randomized controlled trials lacking prospective registration and blinded assessment were excluded.
The cumulative evidence suggests that femoral triangle blocks outperform placebo and periarticular infiltration. When combined with the latter, femoral triangle blocks are associated with improved pain control, higher patient satisfaction and decreased opioid consumption. Continuous femoral triangle blocks provide superior postoperative analgesia compared with their single-injection counterparts. However, these benefits seem less pronounced when perineural adjuvants are used. Combined femoral triangle-obturator blocks result in improved analgesia and swifter discharge compared with femoral triangle blocks alone.
The optimal analgesic strategy for TKR may include a combination of different analgesic modalities (periarticular infiltration, femoral triangle blocks, obturator nerve block). Future trials are required to investigate the incremental benefits provided by local anesthetic infiltration between the popliteal artery and the capsule of the knee (IPACK), popliteal plexus block and genicular nerve block.
本范围综述调查了全膝关节置换术（TKR）患者使用的保留运动神经的镇痛干预措施的最佳组合。
范围综述。
检索了 MEDLINE、EMBASE 和 CINAHL 数据库（成立-5 月最后一周）。仅纳入包含保留运动神经干预措施的试验。排除缺乏前瞻性登记和盲法评估的随机对照试验。
累积证据表明，股三角阻滞优于安慰剂和关节周围浸润。当与后者联合使用时，股三角阻滞与改善疼痛控制、更高的患者满意度和减少阿片类药物消耗相关。与单次注射相比，连续股三角阻滞提供更好的术后镇痛。然而，当使用神经周围辅助剂时，这些益处似乎不太明显。与单独使用股三角阻滞相比，股三角-闭孔神经阻滞联合可改善镇痛效果并更快出院。
TKR 的最佳镇痛策略可能包括不同镇痛方式（关节周围浸润、股三角阻滞、闭孔神经阻滞）的联合。需要进一步的试验来研究股动脉和膝关节囊之间（IPACK）、隐神经丛阻滞和膝神经阻滞的局部麻醉浸润提供的增量效益。
