Hippalgaonkar Kushal, Chandak Vivek, Daultani Deepesh, Mulpur Praharsha, Eachempati Krishna Kiran, Reddy A V Gurava
Sunshine Bone and Joint Institute, Department of Orthopaedics, Sunshine Hospitals, Secunderabad, India.
Medicover Hospitals, Hyderabad, India.
Bone Jt Open. 2021 Dec;2(12):1082-1088. doi: 10.1302/2633-1462.212.BJO-2021-0119.R1.
AIMS: Single-shot adductor canal block (ACB) after total knee arthroplasty (TKA) for postoperative analgesia is a common modality. Patients can experience breakthrough pain when the effect of ACB wears off. Local anaesthetic infusion through an intra-articular catheter (IAC) can help manage breakthrough pain after TKA. We hypothesized that combined ACB with ropivacaine infusion through IAC is associated with better pain relief compared to ACB used alone. METHODS: This study was a prospective double-blinded placebo-controlled randomized controlled trial to compare the efficacy of combined ACB+ IAC-ropivacaine infusion (study group, n = 68) versus single-shot ACB+ intra-articular normal saline placebo (control group, n = 66) after primary TKA. The primary outcome was assessment of pain, using the visual analogue scale (VAS) recorded at 6, 12, 24, and 48 hours after surgery. Secondary outcomes included active knee ROM 48 hours after surgery and additional requirement of analgesia for breakthrough pain. RESULTS: The study group (mean visual analogue scale (VAS) pain score of 5.5 (SD 0.889)) experienced significant reduction in pain 12 hours after surgery compared to the control group (mean VAS 6.62 (SD 1.356); mean difference = 1.12, 95% confidence interval (CI) -1.46 to 0.67; p < 0.001), and pain scores on postoperative day (POD) 1 and POD-2 were lower in the study group compared to the control group (mean difference in VAS pain = 1.04 (-1.39 to -0.68, 95% CI, p < 0.001). Fewer patients in the study group (0 vs 3 in the control group) required additional analgesia for breakthrough pain, but this was not statistically significant. The study group had significantly increased active knee flexion (mean flexion 86.4° (SD 7.22°)), compared to the control group (mean 73.86° (SD 7.88°), mean difference = 12.54, 95% CI 9.97 to 15.1; p < 0.014). CONCLUSION: Combined ACB+ ropivacaine infusion via IAC is a safe, reproducible analgesic modality after primary TKA, with superior analgesia compared to ACB alone. Further large volume trials are warranted to generate evidence on clinical significance on analgesia after TKA. Cite this article: 2021;2(12):1082-1088.
目的：全膝关节置换术（TKA）后采用单次股腘肌管阻滞（ACB）进行术后镇痛是一种常见方式。当ACB的效果消退时，患者可能会经历突破性疼痛。通过关节内导管（IAC）输注局部麻醉剂有助于控制TKA后的突破性疼痛。我们假设与单独使用ACB相比，ACB联合通过IAC输注罗哌卡因能带来更好的疼痛缓解效果。 方法：本研究是一项前瞻性双盲安慰剂对照随机对照试验，旨在比较初次TKA后ACB联合IAC-罗哌卡因输注（研究组，n = 68）与单次ACB联合关节内生理盐水安慰剂（对照组，n = 66）的疗效。主要结局是使用术后6、12、24和48小时记录的视觉模拟量表（VAS）评估疼痛。次要结局包括术后48小时的主动膝关节活动度（ROM）以及突破性疼痛额外所需的镇痛措施。 结果：与对照组（平均VAS 6.62（标准差1.356））相比，研究组（平均视觉模拟量表（VAS）疼痛评分为5.5（标准差0.889））在术后12小时疼痛明显减轻（平均差值 = 1.12，95%置信区间（CI）-1.46至0.67；p < 0.001），并且研究组术后第1天（POD）和第2天的疼痛评分低于对照组（VAS疼痛平均差值 = 1.04（-1.39至-0.68，95% CI，p < 0.001）。研究组中因突破性疼痛需要额外镇痛的患者较少（0例，对照组为3例），但这无统计学意义。与对照组（平均73.86°（标准差7.88°））相比，研究组的主动膝关节屈曲明显增加（平均屈曲86.4°（标准差7.22°）），平均差值 = 12.54，95% CI 9.97至15.1；p < 0.014）。 结论：初次TKA后，ACB联合通过IAC输注罗哌卡因是一种安全、可重复的镇痛方式，与单独使用ACB相比具有更好的镇痛效果。有必要进行进一步的大样本试验以获取关于TKA后镇痛临床意义的证据。引用本文：2021；2(12):1082 - 1088。
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