Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
Department of Anaesthesia and Intensive Care, Medical University of Graz, Graz, Austria.
Knee Surg Sports Traumatol Arthrosc. 2022 Dec;30(12):4046-4053. doi: 10.1007/s00167-022-06868-w. Epub 2022 Feb 3.
After primary total knee arthroplasty (TKA), local periarticular infiltration anaesthesia (LIA) is a fast and safe method for postoperative pain control. Moreover, ultrasound-guided regional anaesthesia (USRA) with femoral and popliteal block is a standard procedure in perioperative care. Two analgesic regimens for TKA-LIA versus URSA with dexmedetomidine-were compared as an additive to ropivacaine. We hypothesised that the use of URSA provides a superior opioid sparing effect for TKA compared with LIA.
Fifty patients (planned 188 participants; safety analysis was performed after examining the first 50 participants) were randomised. These patients received LIA into the knee capsule during surgery with 60 ml of ropivacaine 0.5% and 1 ml of dexmedetomidine (100 µg ml) or two single-shot URSA blocks (femoral and popliteal block) before surgery with 15 ml of ropivacaine 0.5% and 0.5 ml of dexmedetomidine for each block. Postoperative opioid consumption in the first 48 h, pain assessment and complications were analysed.
In the safety analysis, there was a significantly higher need for opioids in the LIA group, with a median oral morphine equivalent of 42.0 [interquartile range (IQR) 23.5-57.0] mg versus 27.0 [IQR 0.0-33.5] mg (P = 0.022). Due to this finding, the study was terminated for ethical considerations according to the protocol.
This is the first study presenting data on LIA application in combination with dexmedetomidine. A superior opioid-sparing effect of URSA was observed when compared with LIA in TKA when dexmedetomidine is added to local anaesthetics. Also, a longer lasting opioid-sparing effect in the LIA group was observed when compared with the recently published literature; this difference could be attributed to the addition of dexmedetomidine. Therefore, multimodal analgesia regimens could be further improved when LIA or USRA techniques are combined with dexmedetomidine.
初次全膝关节置换术后，局部关节周围浸润麻醉（LIA）是一种快速且安全的术后止痛方法。此外，股神经和隐神经阻滞的超声引导区域阻滞（USRA）是围手术期护理的标准程序。我们比较了两种用于 TKA 的镇痛方案：LIA 联合罗哌卡因与 USRA 联合右美托咪定。我们假设与 LIA 相比，USRA 可提供更好的 TKA 阿片类药物节省效果。
50 名患者（计划纳入 188 名参与者；在检查了前 50 名参与者后进行了安全性分析）被随机分组。这些患者在手术中接受膝关节囊内 LIA，用 60ml 0.5%罗哌卡因和 1ml 右美托咪定（100μg/ml）；或在手术前接受两次单剂量 USRA 阻滞（股神经和隐神经阻滞），每侧阻滞用 15ml 0.5%罗哌卡因和 0.5ml 右美托咪定。分析术后 48 小时内的阿片类药物消耗、疼痛评估和并发症。
在安全性分析中，LIA 组需要阿片类药物的中位数明显更高，口服吗啡等效物中位数为 42.0[四分位距（IQR）23.5-57.0]mg 与 27.0[IQR 0.0-33.5]mg（P=0.022）。基于这一发现，根据协议，出于伦理考虑，该研究提前终止。
这是第一项研究报告 LIA 联合右美托咪定应用的数据。当在 TKA 中添加右美托咪定时，与 LIA 相比，USRA 具有更好的阿片类药物节省作用。与最近发表的文献相比，LIA 组的阿片类药物节省作用持续时间更长；这种差异可能归因于右美托咪定的添加。因此，当 LIA 或 USRA 技术与右美托咪定联合使用时，多模式镇痛方案可以进一步改善。
