The Affiliated Hospital of Qingdao University, Department of Anesthesiology, Qingdao, China; Women and Children's Hospital, Qingdao University, Department of Anesthesiology, Qingdao, China.
The Affiliated Hospital of Qingdao University, Department of Operating Room, Qingdao, China.
Braz J Anesthesiol. 2022 Jan-Feb;72(1):110-114. doi: 10.1016/j.bjane.2021.04.012. Epub 2021 Apr 26.
This study aimed to evaluate the impact of Infiltration between the Popliteal Artery and Capsule of the posterior Knee (IPACK) combined with an adductor canal block under the guidance of ultrasound on early motor function after Total Knee Arthroplasty (TKA).
A sample of 60 cases who were scheduled for elective unilateral TKA were divided into two groups using random number table method: a group with IPACK combined with an adductor canal block (I group, n = 30), and a group with femoral nerve block combined with superior popliteal sciatic nerve block (FS group, n = 30). Before anesthesia induction was completed, the patients in I group received an ultrasound-guided adductor canal block with 15 mL of 0.375% ropivacaine and an IPACK block with 25 mL of ropivacaine, and the patients in FS group received a femoral nerve block and a superior popliteal sciatic nerve block with 20 mL of 0.375% ropivacaine under ultrasound guidance. Post-operation, all the patients received patient-controlled intravenous analgesia combined with an oral celecoxib capsule to relieve pain and maintain a visual analogue scale score of ≤ 3.
The quadriceps femoris muscle strength score was significantly higher in Ⅰ group than in FS group (p = 0.001), while the modified Bromage score were significantly lower and walking distance results were significantly higher in Ⅰ group than in FS group (both p = 0.000).
Compared with femoral nerve block combined with superior popliteal sciatic nerve block, IPACK combined with adductor canal block had a mild impact on early motor functions after TKA.
本研究旨在评估在超声引导下将隐动脉与后膝关节囊之间的浸润（IPACK）与内侧隐神经阻滞联合应用对全膝关节置换术后早期运动功能的影响。
采用随机数字表法将 60 例行择期单侧全膝关节置换术的患者分为两组：IPACK 联合隐神经阻滞组（I 组，n=30）和股神经阻滞联合坐骨神经上隐神经阻滞组（FS 组，n=30）。在完成麻醉诱导之前，I 组患者接受超声引导下的隐神经阻滞，注射 15 mL 0.375%罗哌卡因，同时接受 IPACK 阻滞，注射 25 mL 罗哌卡因；FS 组患者接受超声引导下的股神经阻滞和坐骨神经上隐神经阻滞，注射 20 mL 0.375%罗哌卡因。术后，所有患者均接受患者自控静脉镇痛联合口服塞来昔布胶囊以缓解疼痛，使视觉模拟评分≤3。
I 组患者的股四头肌肌力评分明显高于 FS 组（p=0.001），而改良 Bromage 评分明显低于 FS 组，行走距离明显长于 FS 组（均 p=0.000）。
与股神经阻滞联合坐骨神经上隐神经阻滞相比，IPACK 联合隐神经阻滞对 TKA 后早期运动功能的影响较轻。
