Freccero David M, Van Steyn Peter, Joslin Patrick M N, Robbins Claire E, Li Xinning, Efremov Kristian, Shukla Pinak, Talmo Carl T, Bono James V
Boston University School of Medicine, Boston, Massachusetts.
Madigan Medical Center, Tacoma, Washington.
JB JS Open Access. 2022 Aug 4;7(3). doi: 10.2106/JBJS.OA.21.00155. eCollection 2022 Jul-Sep.
Peripheral nerve blocks improve both pain control and functional outcomes following total knee arthroplasty (TKA). However, few studies have examined the effects of different peripheral nerve block protocols on postoperative range of motion. The present study assessed the impact of a single-shot femoral nerve block (SFNB) versus continuous femoral nerve block (CFNB) on postoperative range of motion and the need for subsequent manipulation following TKA.
We retrospective reviewed patient charts to identify patients who had undergone primary elective unilateral TKA by 2 surgeons at a high-volume orthopaedic specialty hospital over a 3-year period. A total of 1,091 patients received either SFNB or CFNB and were included in the data analysis. Identical surgical techniques, postoperative oral analgesic regimens, and rehabilitation protocols were used for all patients. Patients with <90° of flexion at 6 weeks postoperatively underwent closed manipulation under anesthesia (MUA).
Overall, 608 patients (55.7%) received CFNB and 483 patients (44.3%) received SFNB. Overall, 94 patients (8.6%) required postoperative manipulation for stiffness, including 36 (5.9%) in the CFNB group and 58 (12%) in the SFNB group. The 50% reduction in the need for manipulation in the CFNB group was independent of primary surgeon (p > 0.05). No significant differences were observed between the groups in terms of postoperative range of motion, either at the time of discharge or at 6 weeks postoperatively. A history of knee surgery, decreased preoperative range of motion, and decreased range of motion at the time of discharge were significantly associated with the need for further MUA (p = 0.0002, p < 0.0001, and p < 0.0001, respectively).
Despite similar final postoperative range of motion between patients in both groups, our results suggest that CFNB may be superior to SFNB for reducing the need for postoperative manipulation after primary TKA. Furthermore, a history of ipsilateral knee surgery, decreased preoperative range of motion, and decreased range of motion at the time of discharge were identified as independent risk factors for postoperative stiffness requiring MUA after primary TKA.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
全膝关节置换术（TKA）后，周围神经阻滞可改善疼痛控制和功能结局。然而，很少有研究探讨不同周围神经阻滞方案对术后活动范围的影响。本研究评估了单次股神经阻滞（SFNB）与连续股神经阻滞（CFNB）对TKA术后活动范围及后续手法治疗需求的影响。
我们回顾性查阅了患者病历，以确定在一家大型骨科专科医院，由2名外科医生在3年期间进行初次择期单侧TKA的患者。共有1091例接受SFNB或CFNB的患者纳入数据分析。所有患者均采用相同的手术技术、术后口服镇痛方案和康复方案。术后6周屈曲度<90°的患者在麻醉下进行闭合手法治疗（MUA）。
总体而言，608例患者（55.7%）接受了CFNB，483例患者（44.3%）接受了SFNB。总体而言，94例患者（8.6%）因僵硬需要术后手法治疗，其中CFNB组36例（5.9%），SFNB组58例（12%）。CFNB组手法治疗需求减少50%与主刀医生无关（p>0.05）。两组在出院时或术后6周的术后活动范围方面未观察到显著差异。膝关节手术史、术前活动范围减小以及出院时活动范围减小与进一步MUA的需求显著相关（分别为p = 0.0002、p<0.0001和p<0.0001）。
尽管两组患者术后最终活动范围相似，但我们的结果表明，CFNB在减少初次TKA术后手法治疗需求方面可能优于SFNB。此外，同侧膝关节手术史、术前活动范围减小以及出院时活动范围减小被确定为初次TKA后需要MUA治疗的术后僵硬的独立危险因素。
治疗性III级。有关证据水平的完整描述，请参阅作者指南。
