Department of Orthopaedics, Toowoomba Hospital, Toowoomba, Queensland, Australia.
School of Medicine, Rural Clinical School, University of Queensland, Toowoomba, Queensland, Australia.
J Knee Surg. 2022 Nov;35(13):1491-1494. doi: 10.1055/s-0041-1726417. Epub 2021 Apr 14.
Total knee arthroplasty (TKA) is associated with significant postoperative pain. The population receiving TKA is generally elderly and often have multiple comorbidities that can present a challenge to postoperative management. Safe and effective multimodal pain management has led to improved outcomes while minimizing complications and side effects. The objective of this study was to investigate the efficacy of adductor canal blocks (ACB) in patients receiving TKA within a regional Queensland population. We performed a retrospective comparative cohort analysis of 458 patients who received TKA at a regional private hospital between January 2016 and December 2018. Inclusion criteria included body mass index (BMI) <50 kg/m and unilateral TKA. Using the patients' hospital records, age, gender, American Society of Anesthesiologists' score (ASA), BMI, diabetic status, length of stay (LOS), opioid requirement on discharge, range of motion (ROM) on discharge, return to theater, and readmission within 12 months were recorded. One hundred and thirty-eight patients received ACB and 263 did not. The two groups were comparable for age, gender, diabetic status, and ASA. Patients who received an ACB had an 18-hour longer LOS ( < 0.0001), but were discharged on lower dosages of opioids equivalent to 7.9 oral morphine milligram equivalent (MME; < 0.0001). Patients who had an ACB had a similar ROM on discharge and did not have an increased rate of readmission or return to theater. This study demonstrates that ACB are efficacious when used as part of a multimodal analgesia regime for TKA.
全膝关节置换术（TKA）与显著的术后疼痛相关。接受 TKA 的人群通常为老年人，且常有多种合并症，这对术后管理提出了挑战。安全有效的多模式疼痛管理可改善预后，同时将并发症和副作用的风险最小化。本研究旨在调查在昆士兰地区的人群中，股神经阻滞（ACB）在接受 TKA 患者中的疗效。我们对一家地区私立医院在 2016 年 1 月至 2018 年 12 月期间接受单侧 TKA 的 458 例患者进行了回顾性比较队列分析。纳入标准包括体重指数（BMI）<50kg/m 和单侧 TKA。我们使用患者的住院记录，记录年龄、性别、美国麻醉医师协会（ASA）评分、BMI、糖尿病状态、住院时间（LOS）、出院时阿片类药物需求、出院时的活动范围（ROM）、重返手术室以及 12 个月内再入院情况。138 例患者接受了 ACB，263 例患者未接受 ACB。两组在年龄、性别、糖尿病状态和 ASA 方面具有可比性。接受 ACB 的患者 LOS 延长 18 小时（<0.0001），但出院时阿片类药物剂量较低，相当于 7.9 口服吗啡毫克当量（MME；<0.0001）。接受 ACB 的患者出院时 ROM 相似，且再入院或重返手术室的发生率未增加。本研究表明，ACB 作为 TKA 多模式镇痛方案的一部分是有效的。
