Narayan Priti, Sahitya Vijay A, Chandrashekaraiah Mahesh M, Butt Ahsan J, Johnston Keith A, Skowronski Sharon
Department of Anaesthesia and Pain Medicine, King Hamad University Hospital, Al Sayh, Kingdom of Bahrain.
Department of Orthopedics, King Hamad University Hospital, Al Sayh, Kingdom of Bahrain.
Anesth Essays Res. 2021 Jan-Mar;15(1):32-37. doi: 10.4103/aer.aer_58_21. Epub 2021 Aug 30.
Good quality analgesia posttotal knee arthroplasty (TKA) contributes majorly to early mobilization and shorter hospital stay.
To compare adductor canal block (ACB) versus local infiltration analgesia (LIA) for postoperative pain relief in patients undergoing TKA.
This prospective, single-blind, randomized controlled trial was undertaken at a tertiary care university hospital.
Sixty patients of American Society of Anesthesiologists physical status Classes I, II, and III, who received spinal anesthesia for TKA were randomly allocated to two groups. Group A patients had LIA of the knee joint using a mixture of 50 mL of 0.25% bupivacaine, 10 mg morphine (1 mL) and 99 mL of normal saline. Group B patients received ACB using 25 mL of 0.5% bupivacaine under ultrasound guidance. All patients received multimodal analgesia comprising of paracetamol, diclofenac, and patient controlled analgesia with morphine in the first 24 h' postoperative period. The primary outcome measures were first 24 h' morphine consumption and pain scores at 4, 6, 8, 12, and 24 h. The secondary outcome measures were nausea/vomiting, sedation, and patient satisfaction scores.
Statistical analysis was performed using the Student's -test, Mann-Whitney test, and Chi-square test.
The 24 h morphine consumption was 11.97 ± 7.97 and 10.83 ± 6.41 mg in the LIA group and ACB group, respectively ( = 0.54). No significant differences were noted either in the pain scores at rest and flexion or secondary outcome measures between both groups in the first 24 h.
Single-shot ACB is equally effective as LIA as postoperative analgesia for TKA.
全膝关节置换术（TKA）后高质量的镇痛对早期活动和缩短住院时间有重要作用。
比较收肌管阻滞（ACB）与局部浸润镇痛（LIA）用于TKA患者术后疼痛缓解的效果。
本前瞻性、单盲、随机对照试验在一家三级护理大学医院进行。
60例美国麻醉医师协会身体状况分级为I、II和III级、接受TKA脊髓麻醉的患者被随机分为两组。A组患者使用50 mL 0.25%布比卡因、10 mg吗啡（1 mL）和99 mL生理盐水的混合物进行膝关节局部浸润镇痛。B组患者在超声引导下使用25 mL 0.5%布比卡因进行收肌管阻滞。所有患者在术后24小时内接受由对乙酰氨基酚、双氯芬酸和吗啡患者自控镇痛组成的多模式镇痛。主要观察指标为术后24小时内吗啡的首次用量以及4、6、8、12和24小时的疼痛评分。次要观察指标为恶心/呕吐、镇静和患者满意度评分。
采用Student's t检验、Mann-Whitney检验和卡方检验进行统计分析。
LIA组和ACB组术后24小时吗啡用量分别为11.97±7.97 mg和10.83±6.41 mg（P = 0.54）。两组在术后24小时内静息和屈曲时的疼痛评分及次要观察指标均无显著差异。
单次收肌管阻滞作为TKA术后镇痛与局部浸润镇痛同样有效。
