Chen Junheng, Zhou Chunbin, Ma Chuzhou, Sun Guoliang, Yuan Lianxiong, Hei Ziqing, Guo Chunming, Yao Weifeng
Department of Anesthesiology, Shantou Central Hospital, Shantou, China.
Department of Orthopedic, First Affiliated Hospital of Shantou University, Guangdong Province, People's Republic of China.
J Clin Anesth. 2021 Feb;68:110098. doi: 10.1016/j.jclinane.2020.110098. Epub 2020 Oct 28.
To review all randomized controlled trials (RCTs) comparing the analgesic efficacy of adductor canal block (ACB), periarticular infiltration (PAI), and any other mode of these treatments in analgesia, such as PAI with liposomal bupivacaine (LB), continuous adductor canal block (cACB) or ACB + PAI, after total knee arthroplasty (TKA).
Systematic review and network meta-analysis of RCTs.
We searched PubMed, Embase, and the Cochrane database to detect all relevant RCTs on investigating the analgesic effects of ACB, PAI and LB for TKA published until April 2020.
Use of different analgesic methods of ACB, PAI, cACB, ACB + PAI and LB.
The primary endpoint was visual analog scale (VAS) score at rest and movement. The secondary endpoints were opioids consumption, length of hospitalization and knee range of motion (ROM). We used Cochrane risk of bias to assess the quality of evidence for outcomes.
Forty-two studies involving 3785 patients with 5 different methods containing ACB, PAI, ACB + PAI, continuous ACB (cACB), LB, were evaluated. According to surface under the cumulative ranking curve value, 24 h resting VAS score was the lowest the ACB + PAI (88.4%), followed by cACB (73.4%); Resting VAS score at 48 h and movement VAS score at 24 h and 48 h was the lowest in the cACB (99.9%, 92% and 100%). Total opioids consumption was the least in LB (81.4%) before cACB (60.8%). ROM was the largest in the ACB + PAI (84.1%) before cACB (78.8%).
Although all analgesic methods available were not evaluated, and further studies are needed to establish our results, the 24 h resting VAS score was lowest in ACB + PAI and 48 h resting and movement VAS score was lowest in cACB.
PROSPERO (CRD 42020168102).
回顾所有比较内收肌管阻滞（ACB）、关节周围浸润（PAI）以及这些治疗方法的任何其他镇痛模式（如脂质体布比卡因（LB）的PAI、连续内收肌管阻滞（cACB）或ACB + PAI）在全膝关节置换术（TKA）后镇痛效果的随机对照试验（RCT）。
RCT的系统评价和网状Meta分析。
我们检索了PubMed、Embase和Cochrane数据库，以查找截至2020年4月发表的所有关于研究ACB、PAI和LB对TKA镇痛效果的相关RCT。
使用ACB、PAI、cACB、ACB + PAI和LB等不同的镇痛方法。
主要终点是静息和活动时的视觉模拟量表（VAS）评分。次要终点是阿片类药物消耗量、住院时间和膝关节活动范围（ROM）。我们使用Cochrane偏倚风险评估结局的证据质量。
评估了42项研究，涉及3785例患者，采用了5种不同方法，包括ACB、PAI、ACB + PAI、连续ACB（cACB）、LB。根据累积排序曲线下面积值，24小时静息VAS评分在ACB + PAI组最低（88.4%），其次是cACB组（73.4%）；48小时静息VAS评分以及24小时和48小时活动VAS评分在cACB组最低（分别为99.9%、92%和100%）。总阿片类药物消耗量在LB组最少（81.4%），其次是cACB组（60.8%）。ROM在ACB + PAI组最大（84.1%），其次是cACB组（78.8%）。
尽管未评估所有可用的镇痛方法，且需要进一步研究来证实我们的结果，但24小时静息VAS评分在ACB + PAI组最低，48小时静息和活动VAS评分在cACB组最低。
PROSPERO（CRD 42020168102）。
