Department of Anesthesiology, Clinique Medipole Garonne, Toulouse, France.
Department of Anesthesiology, Clinique Medipole Garonne, Toulouse, France.
Br J Anaesth. 2022 Sep;129(3):427-434. doi: 10.1016/j.bja.2022.05.024. Epub 2022 Jun 28.
Many regional anaesthetic techniques have been proposed to manage pain after total knee arthroplasty, but the best approach is unclear. We compared opioid consumption in the first 48 h between two different regional anaesthesia strategies in patients undergoing total knee arthroplasty.
In this single-centre, prospective study, we randomly allocated 90 patients to a combination of IPACK (interspace between popliteal artery and capsule of the posterior knee), triangle femoral and obturator nerve blocks (distal group), or a combination of sciatic, femoral, obturator, and lateral femoral cutaneous nerve blocks (proximal group). All patients received an opioid-sparing general anaesthesia regimen. The primary outcome was opioid consumption in the first 48 h. Secondary outcomes included opioid consumption in the first 24 h and verbal rating pain scores in the first 48 h.
There was no difference in median cumulative oral morphine equivalent consumption at 48 h between the distal and the proximal block groups (33 [18-78] mg vs 30 [22-51] mg, respectively; P=0.29). Median oral morphine equivalent consumption at 24 h was higher in the distal group compared with the proximal group (30 [13-59] vs 15 [0-18], respectively; P<0.001). Verbal rating pain scores were lower in the proximal group compared with the distal group on arrival to the postanaesthesia care unit and at 6 and 12 h.
In patients undergoing total knee arthroplasty under total intravenous general anaesthesia with a multimodal analgesia regimen, proximal nerve blocks resulted in improved pain scores in the first 12 h and reduced opioid consumption in the first 24 h when compared with distal nerve blocks. No difference in pain scores or opioid consumption was seen at 48 h.
NCT04499716.
许多区域麻醉技术已被提出用于管理全膝关节置换术后的疼痛，但最佳方法尚不清楚。我们比较了两种不同的区域麻醉策略在接受全膝关节置换术的患者中在术后 48 小时内的阿片类药物消耗量。
在这项单中心前瞻性研究中，我们将 90 例患者随机分配到 IPACK（胭动脉和后膝关节囊之间的间隙）、三角股神经和闭孔神经阻滞（远端组）或坐骨神经、股神经、闭孔神经和股外侧皮神经阻滞（近端组）的联合应用。所有患者均接受阿片类药物节约型全身麻醉方案。主要结局是术后 48 小时内的阿片类药物消耗量。次要结局包括术后 24 小时内的阿片类药物消耗量和术后 48 小时内的视觉模拟疼痛评分。
在远端和近端阻滞组之间，48 小时内累积口服吗啡等效消耗量中位数无差异（分别为 33 [18-78] mg 与 30 [22-51] mg；P=0.29）。与近端组相比，远端组在术后 24 小时时的口服吗啡等效消耗量更高（30 [13-59] vs 15 [0-18]；P<0.001）。与远端组相比，在到达麻醉后护理单元时以及在 6 小时和 12 小时时，近端组的视觉模拟疼痛评分较低。
在接受全静脉全身麻醉和多模式镇痛方案的全膝关节置换术患者中，与远端神经阻滞相比，近端神经阻滞在术后前 12 小时可改善疼痛评分，并减少术后前 24 小时的阿片类药物消耗。在 48 小时时，疼痛评分或阿片类药物消耗无差异。
NCT04499716。
