Marya S K S, Arora Deep, Singh Chandeep, Kacker Shitij, Desai Rahul, Lodha Vikas
Bone & Joint Institute, Medanta, Medicity, H Baktawar Singh Road Sector 38, Gurugram, Haryana, India.
Arthroplasty. 2020 May 20;2(1):15. doi: 10.1186/s42836-020-00034-8.
Pain management after total knee arthroplasty (TKA) is important as acute postoperative pain can affect patient's ability to walk and participate in rehabilitation required for good functional outcome. This is achieved by effective intra-operative and post-operative analgesia to facilitate early recovery. Adductor canal block (ACB) and local infiltration analgesia (LIA) are analgesic regimens and commonly used for effective post-operative analgesia after TKA. Our aim was to compare the efficacy and outcomes of these two methods, combined and independently.
Our study included 120 patients undergoing unilateral TKA, who were randomized into three groups: LIA (Group I), ACB (Group II) and combined LIA + ACB (Group III). Patients were operated by a single surgeon. The outcome was defined by post-operative analgesia achieved by the three techniques (measured by the NPRS) and amount of fentanyl consumed postoperatively. Secondary outcome was evaluated based on postoperative functional outcomes in terms of ability to stand, distance covered, range of motion of knee on the 1st post-operative day, complications and WOMAC (Western Ontario & McMaster Universities Osteoarthritis Index) scores.
All patients were available for analysis. Numerical Pain Rating Scale for pain showed significant differences at 24 h between Group I and Group II, with a p value of 0.018 (GroupI was better), significant differences were found at 24 h between Group III and Group II, with p values being 0.023 and 0.004 (GroupIII was better). No significant differences were found between Group I and Group III at 24 h. Total fentanyl consumption was significantly less in Group III than in Group I and Group II, with p value being 0.042 and 0.005, respectively (Group III was better and consumed less fentanyl). No significant differences were found in WOMAC scores between the three groups at baseline, 2 and 6 weeks after operation.
In patients undergoing TKA, analgesic effect of combined ACB and LIA was superior, as indicated by reduced opioid consumption and no differences in functional outcomes and complications were observed as compared to separate use of the two techniques.
全膝关节置换术（TKA）后的疼痛管理很重要，因为术后急性疼痛会影响患者行走以及参与康复训练的能力，而良好的功能恢复需要有效的康复训练。这可通过有效的术中及术后镇痛来促进早期恢复。收肌管阻滞（ACB）和局部浸润镇痛（LIA）是镇痛方案，常用于TKA术后的有效镇痛。我们的目的是比较这两种方法单独使用及联合使用时的疗效和结果。
我们的研究纳入了120例行单侧TKA的患者，他们被随机分为三组：LIA组（I组）、ACB组（II组）和LIA + ACB联合组（III组）。所有患者均由同一位外科医生进行手术。结果通过三种技术实现的术后镇痛效果（用数字疼痛评分量表[NPRS]测量）以及术后芬太尼消耗量来定义。次要结果根据术后第1天的站立能力、行走距离、膝关节活动范围、并发症以及西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评分等功能结果进行评估。
所有患者均可供分析。疼痛的数字疼痛评分量表显示，I组和II组在24小时时有显著差异，p值为0.018（I组更好）；III组和II组在24小时时有显著差异，p值分别为0.023和0.004（III组更好）。I组和III组在24小时时未发现显著差异。III组的总芬太尼消耗量显著低于I组和II组，p值分别为0.042和0.005（III组更好，芬太尼消耗量更少）。三组在基线、术后2周和6周时的WOMAC评分未发现显著差异。
在接受TKA的患者中，ACB和LIA联合使用的镇痛效果更佳，表现为阿片类药物消耗量减少，与单独使用这两种技术相比，功能结果和并发症方面未观察到差异。
