Department of Anaesthesiology, All India Institute of Medical Sciences, Patna, India.
Department of Anaesthesiology, Nalanda Medical College and Hospital, Patna, India.
Braz J Anesthesiol. 2022 Sep-Oct;72(5):553-559. doi: 10.1016/j.bjane.2021.03.017. Epub 2021 Apr 24.
Anterior cruciate ligament reconstruction (ACLR) is one of the most frequently performed orthopedic procedures. The ability to perform ACLR on an outpatient basis is largely dependent on an effective analgesic regimen. The aim of the study was to compare the analgesic effect between continuous adductor canal block (cACB) and femoral nerve block (cFNB) during arthroscopy guided ACLR.
In this prospective, randomized, controlled clinical trial, 60 ASA I/II patients for arthroscopic ACLR were recruited. Patients in Group I received cACB and those in Group II cFNB. A bolus dose of 20 cc 0.5% levobupivacaine followed by 0.125% 5 mL.h was started for 24 hours. Rescue analgesia in the form of paracetamol 1 g intravenous (IV) was given. Parameters assessed were time of first rescue analgesia, total analgesic requirement in 24 hours, and painless range of motion of the knee (15 degrees of flexion to further painless flexion).
The time-to-first postoperative analgesic request (hours) was earlier in Group II (14.40 ± 4.32) than Group I (16.90 ± 3.37) and this difference was statistically significant (p < 0.05). The cumulative 24-h analgesic consumption (paracetamol in g) was 0.70 ± 0.47 in Group I and 1.70 ± 0.65 in Group II (p < 0.001). The painless range of motion (degree) was 55.67 ± 10.40 in Group I and 40.00 ± 11.37 in Group II (p < 0.001).
The findings of this study suggest that continuous adductor canal block provides superior analgesia in patients undergoing arthroscopic ACLR when compared to continuous femoral nerve block.
前交叉韧带重建（ACLR）是最常进行的矫形手术之一。能够在门诊进行 ACLR 在很大程度上取决于有效的镇痛方案。本研究的目的是比较关节镜引导下 ACLR 中连续收肌管阻滞（cACB）和股神经阻滞（cFNB）的镇痛效果。
本前瞻性、随机、对照临床试验纳入了 60 例 ASA I/II 级行关节镜 ACLR 的患者。I 组患者接受 cACB，II 组患者接受 cFNB。术后 24 小时内，给予 20cc0.5%左旋布比卡因负荷剂量，随后给予 0.125%5ml.h。给予扑热息痛 1g 静脉（IV）补救镇痛。评估的参数包括首次补救镇痛的时间、24 小时内的总镇痛需求以及膝关节无痛活动范围（15 度屈曲至进一步无痛屈曲）。
与 I 组（16.90±3.37）相比，II 组（14.40±4.32）的术后首次镇痛请求时间更早，差异具有统计学意义（p<0.05）。I 组的 24 小时累积镇痛消耗（扑热息痛 g）为 0.70±0.47，II 组为 1.70±0.65（p<0.001）。I 组无痛活动范围（度）为 55.67±10.40，II 组为 40.00±11.37（p<0.001）。
与连续股神经阻滞相比，连续收肌管阻滞在关节镜下 ACLR 患者中提供了更好的镇痛效果。
