Department of Orthopaedic Surgery, The Third Affiliated Hospital of Chongqing Medical University, ChongQing Medical University, 1# Shuanghu Road, Yubei District, Chongqing City, 401120, China.
Department of Pediatry, Chongqing Health Center for Women and Children, Chongqing City, 401147, China.
Arch Orthop Trauma Surg. 2022 Jun;142(6):913-926. doi: 10.1007/s00402-020-03706-x. Epub 2021 Jan 8.
Perioperative pain after total knee arthroplasty (TKA) may seriously affect the rapid recovery of patients. The purpose of this study was to assess whether the combined use of adductor canal block (ACB) and local infiltration anesthesia (LIA) can further reduce postoperative pain and improve early functional recovery.
PubMed, Web of Science, EMBASE, and Cochrane Central Register of Controlled Trials were systematically searched for randomized controlled trials (RCTs) comparing ACB + LIA and LIA alone in primary TKA. The primary outcomes were visual analog scale (VAS) scores at rest and walking, morphine consumption, range of motion (ROM) at 24 and 48 h postoperatively and distance walked. The secondary outcomes were the length of stay, the incidence of nausea and vomiting, and the total complications. Subgroup analyses were performed on the VAS at rest and walking, morphine consumption, and distance walked at 24, 48, and 72 h postoperatively.
A total of 10 RCTs involving 797 patients were enrolled in this meta-analysis. The results demonstrated that the combined application of ACB + LIA had a lower resting VAS at 24 h postoperatively (p = 0.02) and the walking score at 24 (p = 0.0002) and 48 h (p = 0.02) postoperatively compared with LIA alone. Similarly, the combined ACB + LIA group also had less morphine consumption at 48 h postoperatively (p = 0.0005) and had a higher ROM score at 24 h (p = 0.01) postoperatively compared to the LIA group. There were no statistical differences in length of stay, distance walked, and incidence of nausea and vomiting.
The current meta-analysis showed that ACB + LIA significantly reduced postoperative walking pain and morphine consumption and promoted rapid recovery in the early postoperative period. There is no statistical difference in the length of stay and ROM after 72 h in the two groups.
全膝关节置换术后（TKA）的围手术期疼痛可能会严重影响患者的快速康复。本研究旨在评估股神经阻滞（ACB）联合局部浸润麻醉（LIA）是否能进一步减轻术后疼痛并改善早期功能恢复。
我们系统地检索了 PubMed、Web of Science、EMBASE 和 Cochrane 对照试验中心注册库，以寻找比较原发性 TKA 中 ACB+LIA 与单独 LIA 的随机对照试验（RCT）。主要结局指标为静息和行走时的视觉模拟评分（VAS）、吗啡消耗量、术后 24 和 48 小时的活动范围（ROM）和行走距离。次要结局指标为住院时间、恶心和呕吐的发生率以及总并发症。对术后 24、48 和 72 小时的静息和行走 VAS、吗啡消耗量和行走距离进行亚组分析。
本 meta 分析共纳入 10 项 RCT，共 797 例患者。结果表明，与单独使用 LIA 相比，ACB+LIA 联合应用在术后 24 小时的静息 VAS 评分（p=0.02）和术后 24 小时（p=0.0002）和 48 小时（p=0.02）的行走评分较低。同样，与 LIA 组相比，ACB+LIA 组术后 48 小时吗啡消耗量也较少（p=0.0005），术后 24 小时 ROM 评分较高（p=0.01）。两组在住院时间、行走距离和恶心呕吐发生率方面无统计学差异。
目前的 meta 分析表明，ACB+LIA 可显著减轻术后行走疼痛和吗啡用量，并促进术后早期快速恢复。两组在术后 72 小时的住院时间和 ROM 方面无统计学差异。
