Holbert Samuel Elliott, Baxter Samantha N, Brennan Jane C, Johnson Andrea H, Cheema Minahil, Turcotte Justin J, MacDonald James H, King Paul J
Department of Orthopedics, Anne Arundel Medical Center, Annapolis, MD.
Ochsner J. 2023 Spring;23(1):9-15. doi: 10.31486/toj.22.0074.
As length of stay after total knee arthroplasty (TKA) continues to shorten, interventions that may reduce early postoperative pain and complications must be studied. Peripheral nerve block is being explored as a potential means of improving pain management. The purpose of this study was to evaluate the impact of adductor canal block (ACB) on postoperative outcomes for patients undergoing TKA. We conducted a retrospective review of 565 patients who received unilateral TKA under spinal anesthesia with a periarticular anesthetic injection. Patients were divided by ACB status. Univariate comparisons and multivariate regression were used to compare outcomes for patients receiving ACBs vs those who did not. Of the 565 patients, 167 received an ACB, and 398 did not. Patients who received an ACB were less likely to require nausea medication during the immediate postoperative period. Length of stay, narcotic consumption, rate of discharge to home, postanesthesia care unit recovery time, urinary retention, ability to complete physical therapy, and 30-day readmission rate did not differ significantly between groups. After risk adjustment, the only significant finding was decreased likelihood of nausea in patients receiving an ACB. ACBs appear to have little to no significant impact on early clinical outcomes in patients having TKA under spinal anesthesia with a periarticular anesthetic injection. Further study of larger patient cohorts is required to validate these findings.
随着全膝关节置换术（TKA）后住院时间持续缩短，必须研究可能减轻术后早期疼痛和并发症的干预措施。外周神经阻滞作为改善疼痛管理的一种潜在手段正在被探索。本研究的目的是评估收肌管阻滞（ACB）对接受TKA患者术后结局的影响。我们对565例在脊髓麻醉下接受单侧TKA并进行关节周围麻醉注射的患者进行了回顾性研究。患者根据是否接受ACB进行分组。采用单因素比较和多因素回归分析来比较接受ACB患者与未接受ACB患者的结局。在565例患者中，167例接受了ACB，398例未接受。接受ACB的患者在术后即刻期间需要使用抗恶心药物的可能性较小。两组之间的住院时间、麻醉药品消耗量、回家出院率、麻醉后护理单元恢复时间、尿潴留、完成物理治疗的能力以及30天再入院率没有显著差异。经过风险调整后，唯一显著的发现是接受ACB的患者恶心可能性降低。在接受脊髓麻醉并进行关节周围麻醉注射的TKA患者中，ACB似乎对早期临床结局几乎没有显著影响。需要对更大的患者队列进行进一步研究以验证这些发现。
