Pic Caroline, Macabeo Caroline, Waissi Emran, Lasselin Philippe, Raffin Mahé, Pradat Pierre, Lalande Laure, Lustig Sebastien, Aubrun Frederic, Dziadzko Mikhail
Département d'Anesthésie-Réanimation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard, Lyon, France.
Centre de Recherche Clinique, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard, Lyon, France.
J Bone Joint Surg Am. 2023 Feb 1;105(3):231-238. doi: 10.2106/JBJS.22.00745. Epub 2022 Nov 18.
An adductor canal block (ACB) performed by an anesthesiologist is an established component of analgesia after total knee arthroplasty. Alternatively, surgeons may perform periarticular local infiltration analgesia (LIA) intraoperatively. We hypothesized that ACB would be superior to anterior LIA in terms of morphine consumption in the first 48 hours after primary total knee arthroplasty under spinal anesthesia.
This prospective controlled and blinded trial included 98 patients; 48 received an ACB plus sham (saline solution) anterior LIA, and 50 received a sham (saline solution) ACB plus anterior LIA. Both groups received posterior LIA with local anesthetic. The primary outcome was cumulative morphine consumption at 48 hours after surgery. Secondary outcomes were pain while resting, standing, and walking, rehabilitation scores, opioid-related side effects, and patient satisfaction.
No difference in the primary outcome was found, and the 48-hour morphine consumption was low in both arms (28.8 ± 17.6 mg with ACB, 26.8 ± 19.2 mg with anterior LIA; p = 0.443). Pain scores were significantly better in the anterior LIA arm, but the differences were not clinically relevant. There were no differences in any other secondary outcome measures.
LIA may be used as the primary option for multimodal postoperative pain management in patients undergoing primary total knee arthroplasty with spinal anesthesia.
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
麻醉医生实施的股内侧肌管阻滞（ACB）是全膝关节置换术后镇痛的既定组成部分。另外，外科医生可在术中进行关节周围局部浸润镇痛（LIA）。我们假设，在脊髓麻醉下进行初次全膝关节置换术后的48小时内，ACB在吗啡消耗量方面优于前侧LIA。
这项前瞻性对照双盲试验纳入了98例患者；48例接受ACB加假手术（生理盐水）前侧LIA，50例接受假手术（生理盐水）ACB加前侧LIA。两组均接受局部麻醉药后侧LIA。主要结局是术后48小时的累积吗啡消耗量。次要结局包括静息、站立和行走时的疼痛、康复评分、阿片类药物相关副作用及患者满意度。
未发现主要结局存在差异，两组48小时吗啡消耗量均较低（ACB组为28.8±17.6mg，前侧LIA组为26.8±19.2mg；p=0.443）。前侧LIA组的疼痛评分明显更好，但差异无临床意义。在任何其他次要结局指标上均无差异。
对于接受脊髓麻醉的初次全膝关节置换术患者，LIA可作为多模式术后疼痛管理的主要选择。
治疗性I级。有关证据水平的完整描述，请参阅《作者须知》。
