单次收肌管阻滞在初次全膝关节置换术前后的疗效 - 时机有影响吗？一项随机对照试验。
Efficacy of single-shot adductor canal block before Versus after primary total knee arthroplasty - Does timing make a difference? A randomized controlled trial.
机构信息
Department of Orthopaedic Surgery, 36632Rabin Medical Center, Petach Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Israel.
出版信息
J Orthop Surg (Hong Kong). 2022 Sep-Dec;30(3):10225536221132050. doi: 10.1177/10225536221132050.
BACKGROUND
Total knee arthroplasty (TKA) is associated with severe postoperative pain. Multimodal analgesia, including peripheral nerve block, is recommended for post-operative pain relief. Administration of some pain medications prior to surgery has shown to be more effective than after the operation. This is a prospective, randomized controlled trial designed to compare the analgesic efficacy of the adductor canal block (ACB) performed immediately before or immediately after primary total knee arthroplasty (TKA). We hypothesized that ACB before the surgery will reduce postoperative pain and improve knee function.
METHODS
A total of 50 patients were enrolled and randomized into 2 groups, with 26 patients receiving a preoperative ACB and 24 receiving a postoperative ACB.
RESULTS
Treatment groups were similar in terms of gender ( = .83), age ( = 0.61) weight ( = .39) and ASA score. Average visual analogue scale (VAS) on arrival to the post-anesthesia care unit (PACU) were 4.9 ± 3.2 in the preoperative ACB versus 3.4 ± 2.8 for the postoperative ACB ( = .075). VAS scores at different time points as well as the mean, minimal and maximal reported VAS scores were not significantly different between the two groups. The cumulative quantities of Fentanyl administered by the anesthesia team was comparable between the groups. Similarly, the dosage of Morphine, Tramadol, Acetaminophen and Dipyrone showed only small variations. The Quality of Recovery Score, Knee Society Scores and knee range of motion did not differ between the groups.
CONCLUSIONS
Our findings demonstrate no significant differences in patient total narcotics consumption, pain scores and functional scores, between preoperative and postoperative ACB in patients undergoing TKA.
TRIAL REGISTRATION
The trial was registered at www.clinicaltrials.gov and was assigned the registration number NCT02908711.
LEVEL OF EVIDENCE
level I randomized controlled trial.
背景
全膝关节置换术（TKA）术后疼痛剧烈。多模式镇痛，包括外周神经阻滞，推荐用于术后止痛。手术前给予一些止痛药比手术后更有效。这是一项前瞻性、随机对照试验，旨在比较在初次全膝关节置换术（TKA）前或后即刻行收肌管阻滞（ACB）的镇痛效果。我们假设手术前行 ACB 会减轻术后疼痛并改善膝关节功能。
方法
共纳入 50 例患者，随机分为 2 组，26 例患者接受术前 ACB，24 例患者接受术后 ACB。
结果
治疗组在性别（=0.83）、年龄（=0.61）、体重（=0.39）和 ASA 评分方面相似。到达麻醉后护理病房（PACU）时，术前 ACB 组平均视觉模拟评分（VAS）为 4.9±3.2，术后 ACB 组为 3.4±2.8（=0.075）。两组在不同时间点的 VAS 评分以及报告的平均、最小和最大 VAS 评分均无显著差异。麻醉团队给予的芬太尼累积量在两组之间相似。同样，吗啡、曲马多、对乙酰氨基酚和赖氨匹林的剂量也只有很小的变化。两组间的恢复质量评分、膝关节协会评分和膝关节活动度无差异。
结论
我们的研究结果表明，在接受 TKA 的患者中，与术后 ACB 相比，术前 ACB 对患者总阿片类药物消耗、疼痛评分和功能评分没有显著影响。
试验注册
该试验在 www.clinicaltrials.gov 上注册，并被分配了注册号 NCT02908711。
证据水平
一级随机对照试验。
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