From the Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Turgeon, Bohm); and the Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Aragola, Arenson, Tenenbein, Jacobsohn).
Can J Surg. 2021 Apr 28;64(3):E265-E272. doi: 10.1503/cjs.020519.
Femoral nerve block (NB) and periarticular injection (PI) are 2 common options for pain control after total knee arthroplasty (TKA). We performed a prospective triple-blinded randomized trial comparing continuous femoral NB to PI, with follow-up to 1 year.
Patients younger than 70 years of age who were scheduled to undergo elective primary TKA under spinal anesthesia between 2009 and 2010 were randomly allocated to receive either continuous femoral NB or PI. Patients in the NB group received ropivacaine through an NB catheter and a sham saline PI. The PI group received a PI of ropivacaine, morphine, ketorolac and epinephrine, and a sham saline infusion via an NB catheter. Both groups had standardized oral analgesia preoperatively, spinal anesthesia and sedation, and postoperative analgesia. Surgeons, anesthesiologists, patients and assessors were blinded to group assignment. Pain was measured twice daily on postoperative days 1 and 2, at rest and with motion, with a numeric rating scale. Patient satisfaction, pain (Oxford Knee Score) and range of motion were assessed at 1 year.
There were 39 participants in the NB group and 35 participants in the PI group. There were no statistically significant differences between the groups at baseline. Statistically but nonclinically significant reductions in pain scores on postoperative day 2 and in narcotic need on the day of surgery were found in the PI group. Patient-reported satisfaction did not differ at any time point. At 1 year, knee flexion was significantly greater in the NB group than in the PI group (mean range of motion 120° v. 110°, p = 0.03).
There was no demonstrated improvement in pain control with the use of an NB versus PI when used with multimodal analgesia. Clinicians should opt for the modality that has the best efficiency for their surgical environment. ClinicalTrials.gov # NCT00869037
股神经阻滞（NB）和关节周围注射（PI）是全膝关节置换术后（TKA）两种常见的止痛选择。我们进行了一项前瞻性、三盲、随机试验，比较了连续股神经阻滞与 PI，随访时间为 1 年。
2009 年至 2010 年期间，在接受椎管内麻醉下择期初次 TKA 的年龄小于 70 岁的患者中，随机分配接受连续股神经阻滞或 PI。NB 组患者通过 NB 导管接受罗哌卡因，并接受生理盐水 PI 假治疗。PI 组患者接受罗哌卡因、吗啡、酮咯酸和肾上腺素的 PI，并通过 NB 导管接受生理盐水输注。两组患者均在术前接受标准化口服镇痛、椎管内麻醉和镇静以及术后镇痛。外科医生、麻醉师、患者和评估者对分组均不知情。术后第 1 天和第 2 天，在休息和运动时，使用数字评分量表每天测量 2 次疼痛。1 年后评估患者满意度、疼痛（牛津膝关节评分）和活动范围。
NB 组有 39 名患者，PI 组有 35 名患者。两组患者在基线时无统计学差异。PI 组患者术后第 2 天的疼痛评分和手术当天的阿片类药物需求有统计学但无临床意义的降低。任何时间点患者报告的满意度均无差异。1 年后，NB 组的膝关节屈曲度明显大于 PI 组（平均活动范围 120°对 110°，p = 0.03）。
在多模式镇痛的情况下，使用 NB 与 PI 相比，在疼痛控制方面没有明显改善。临床医生应根据其手术环境选择最有效的方法。ClinicalTrials.gov # NCT00869037
