Del Toro-Pagán Nicole M, Dai Feng, Banack Trevor, Berlin Jill, Makadia Satya A, Rubin Lee E, Zhou Bin, Huynh Phu, Li Jinlei
Department of Pharmacy, Yale New Haven Health - Bridgeport Hospital, Bridgeport, CT, USA.
Applied Precision Pharmacotherapy Institute, Tabula Rasa HealthCare, Moorestown, NJ, USA.
J Pain Res. 2022 Aug 27;15:2537-2546. doi: 10.2147/JPR.S378243. eCollection 2022.
Opioid consumption after total knee arthroplasty (TKA) remains a challenge with single injection nerve blocks even with common local anesthetic adjuvants dexamethasone (DEX). This study aimed to investigate the effects of adding methylprednisolone acetate (MPA) to adductor canal blocks (ACB) and interspace between the popliteal artery and capsule of the posterior knee (iPACK) blocks on postoperative opioid consumption.
A retrospective analysis was conducted on 100 consecutive TKA patients equally assigned into two groups, with one group receiving DEX through ACB and iPACK block and the other group receiving DEX and methylprednisolone acetate (DEX/MPA) through the same nerve blocks. The primary outcome was cumulative opioid consumption (oral milligram morphine equivalent, OME) during hospitalization for up to three days. Secondary outcomes included daily opioid consumption, highest rest and active pain scores, prosthetic knee joint active range of motion (AROM), laboratory studies including fasting serum glucose (FSG) and white blood cell count (WBC) on each postoperative day (POD), and length of hospital stay.
Cumulative opioid consumption was significantly lower in the DEX/MPA group vs DEX group (median difference (95% CI) = -45.3 (-80.5 to -10), P = 0.011). The highest rest and active pain scores were both significantly lower in the DEX/MPA group than in DEX group on POD 2 (least square mean difference (95% CI) = -1.3 (-2.3 to -0.4), P = 0.005 and -0.9 (-1.8 to -0.1), P = 0.031, respectively). Except on POD 1, FSG values were significantly lower in the DEX/MPA group (median difference (95% CI) = -22.5 (-36 to -8.9), P = 0.001). AROM, WBC, and length of stay were comparable between both groups.
Compared to perineural DEX alone, the addition of MPA further decreases postoperative opioid consumption without clinically significant changes on FSG and WBC.
III.
全膝关节置换术（TKA）后即使使用常见的局部麻醉辅助剂地塞米松（DEX），单次注射神经阻滞的阿片类药物消耗量仍然是一个挑战。本研究旨在探讨在收肌管阻滞（ACB）和腘动脉与后膝关节囊间隙阻滞（iPACK）中添加醋酸甲泼尼龙（MPA）对术后阿片类药物消耗量的影响。
对100例连续的TKA患者进行回顾性分析，将其平均分为两组，一组通过ACB和iPACK阻滞接受DEX，另一组通过相同的神经阻滞接受DEX和醋酸甲泼尼龙（DEX/MPA）。主要结局是住院期间长达三天的累积阿片类药物消耗量（口服毫克吗啡当量，OME）。次要结局包括每日阿片类药物消耗量、最高静息和活动疼痛评分、人工膝关节主动活动范围（AROM）、术后每日（POD）的实验室检查，包括空腹血糖（FSG）和白细胞计数（WBC），以及住院时间。
DEX/MPA组的累积阿片类药物消耗量显著低于DEX组（中位数差异（95%CI）=-45.3（-80.5至-10），P=0.011）。在POD 2时，DEX/MPA组的最高静息和活动疼痛评分均显著低于DEX组（最小二乘均值差异（95%CI）=-1.3（-2.3至-0.4），P=0.005和-0.9（-1.8至-0.1），P=0.031）。除了POD 1外，DEX/MPA组的FSG值显著较低（中位数差异（95%CI）=-22.5（-36至-8.9），P=0.001）。两组之间的AROM、WBC和住院时间相当。
与单独使用神经周围DEX相比，添加MPA可进一步降低术后阿片类药物消耗量，且对FSG和WBC无临床显著影响。
III级
