Department of Anesthesiology and Reanimation, Uludağ University, School of Medicine, Bursa, Turkey.
Department of Orthopedics and Traumatology, Uludağ University, School of Medicine, Bursa, Turkey.
Acta Orthop Traumatol Turc. 2021 Mar;55(2):134-140. doi: 10.5152/j.aott.2021.20187.
The aim of this study was to compare the efficacy of popliteal artery and the capsule of the posterior knee (IPACK) block and genicular nerve block on postoperative pain scores, the need for rescue analgesics, range of motion (ROM), walking distance, and perioperative monitorization variables in patients undergoing total knee replacement (TKR) surgery.
Sixty American Society of Anesthesiologists (ASA) physical status I-III patients were enrolled in this study and then were randomly assigned into three groups: the IPACK block group (17 female, 3 male; mean age=67.5±1.4 years), genicular nerve block (16 female, 4 male; mean age=68±1.76 years), and the control group (13 female, 7 male; mean age=63±1.67years). All the patients underwent TKR under spinal anesthesia. The visual analog scale (VAS) score, mobility, pre- and intra-operative monitorization of systolic and diastolic holding area, non-invasive blood pressure, heart rate, and SPO 2 were compared between the groups.
Patients in the IPACK and genicular block groups had a significantly lower visual analogous scale (VAS) at postoperative 4 hours (p<0.01), 8h (p<0.01), 12h (p<0.01), and 24h (p<0.05). VAS score was significantly lower in the genicular block group at the postoperative 4h (5.5±0.55) and 8h (5.0±0.53) in the mobile state compared to the IPACK (8.0±0.47 and 8.0±0.43, respectively) and the control group (9.5±0.20; 10±0.28, respectively) (p< 0.01). The use of patient-controlled-analgesia (PCA) devices and button push count for analgesics demand were significantly lower in the genicular block group on the immediate postoperative period (p<0.01 at the postoperative 0 to 4 h). The total consumption of morphine equivalents on the postoperative day 0 was significantly lower in the genicular block group (p<0.01, and p<0.001 for IPACK and control groups, respectively). The degree of flexion was significantly higher in the genicular block group at the postoperative 12h compared to the IPACK and the control group (p<0.001). The length of hospital stay was significantly lower in the genicular block group compared to the IPACK and the control group (p<0.05 for both variables).
IPACK and genicular blocks both are effective in improving patient comfort during and after TKR surgery and reducing the potential need for systemic analgesic and opioids. The genicular block seems to be a promising technique that can offer improved pain management in the immediate and early postoperative period without adverse effects on systemic and motor variables.
本研究旨在比较腘动脉和膝关节囊（IPACK）阻滞与关节支神经阻滞在全膝关节置换术（TKR）患者术后疼痛评分、需要急救镇痛、关节活动度（ROM）、行走距离以及围手术期监测变量方面的疗效。
本研究纳入了 60 名美国麻醉医师协会（ASA）身体状况 I-III 级的患者，并将其随机分为三组：IPACK 阻滞组（17 名女性，3 名男性；平均年龄=67.5±1.4 岁）、关节支神经阻滞组（16 名女性，4 名男性；平均年龄=68±1.76 岁）和对照组（13 名女性，7 名男性；平均年龄=63±1.67 岁）。所有患者均在脊髓麻醉下接受 TKR。比较三组患者的视觉模拟评分（VAS）、活动能力、术前和术中收缩压和舒张压监测区、无创血压、心率和 SPO 2。
IPACK 和关节支神经阻滞组患者术后 4 小时（p<0.01）、8 小时（p<0.01）、12 小时（p<0.01）和 24 小时（p<0.05）的视觉模拟评分（VAS）明显较低。在移动状态下，关节支神经阻滞组术后 4 小时（5.5±0.55）和 8 小时（5.0±0.53）的 VAS 评分明显低于 IPACK 组（分别为 8.0±0.47 和 8.0±0.43）和对照组（分别为 9.5±0.20 和 10±0.28）（p<0.01）。术后即刻，关节支神经阻滞组患者对患者自控镇痛（PCA）设备的使用和按钮按压次数需求明显低于 IPACK 组和对照组（p<0.01，术后 0 至 4 小时）。术后第 0 天吗啡等效物的总消耗量在关节支神经阻滞组明显较低（p<0.01，与 IPACK 组和对照组相比分别为 p<0.01 和 p<0.001）。与 IPACK 组和对照组相比，关节支神经阻滞组患者术后 12 小时的膝关节屈曲程度明显更高（p<0.001）。与 IPACK 组和对照组相比，关节支神经阻滞组患者的住院时间明显缩短（p<0.05，均为变量）。
IPACK 和关节支神经阻滞均能有效改善 TKR 术后患者的舒适度，减少对全身镇痛和阿片类药物的潜在需求。关节支神经阻滞似乎是一种很有前途的技术，在不影响全身和运动变量的情况下，可以在术后早期提供更好的疼痛管理。
