Section of Orthopedic Surgery, Department of Surgery, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdul Rahman University, Riyadh, Saudi Arabia.
Department of Orthopedic Surgery, Dammam Medical Complex, Dammam, Saudi Arabia.
BMC Musculoskelet Disord. 2023 Mar 22;24(1):214. doi: 10.1186/s12891-023-06263-7.
Continuous local infiltration analgesia (CLIA) can be administered via intraarticular or periarticular techniques in patients undergoing total knee arthroplasty (TKA). The purpose of this investigation was to retrospectively report a single-center experience of epidural analgesia with subcutaneous CLIA versus epidural analgesia without CLIA among patients undergoing TKA.
This single-center retrospective study was conducted in Saudi Arabia. From January 01, 2014, to December 30, 2020, medical records of all patients who underwent TKA were reviewed. Patients who received subcutaneous CLIA with epidural analgesia were assigned to the intervention group, whereas those who received epidural analgesia without subcutaneous CLIA were assigned to the control group. The efficacy endpoints included: (i) postoperative pain scores at 24 h, 48 h, 72 h, and 3 months; (ii) postoperative opioid consumption at 24 h, 48 h, 72 h, and 24-72 h (cumulative); (iii) length of hospital stay; and (iv) postoperative functional recovery of the knee 3 months post-operation, according to the Knee Injury and Osteoarthritis Outcome Score.
At rest and during mobilization, the CLIA group (n = 28) achieved significantly lower postoperative pain scores 24 h, 48 h, 72 h, and 3 months post-operation than the non-CLIA group (n = 35). Subgroup analysis revealed that the CLIA group achieved significantly less opioid consumption 24 h and 48 h post-operation than the non-CLIA group. There was no difference between the groups regarding the length of hospital stay or functional scores 3 months post-operation. There was no significant difference between the groups regarding the rate of wound infection, other infections, and readmission within 30 days.
Subcutaneous CLIA is a technically feasible and safe procedure without major adverse events but with reduced postoperative pain scores (at rest and during mobilization) and opioid consumption. Additional larger studies are warranted to confirm our results. Moreover, a head-to-head comparison between subcutaneous CLIA and periarticular or intraarticular CLIA is an interesting prospective investigation.
在接受全膝关节置换术（TKA）的患者中，连续局部浸润镇痛（CLIA）可通过关节内或关节周围技术给予。本研究的目的是回顾性报告在接受 TKA 的患者中，硬膜外镇痛联合皮下 CLIA 与单纯硬膜外镇痛的单中心经验。
这是一项在沙特阿拉伯进行的单中心回顾性研究。从 2014 年 1 月 1 日至 2020 年 12 月 30 日，回顾了所有接受 TKA 的患者的病历。接受硬膜外镇痛联合皮下 CLIA 的患者被分配到干预组，而接受单纯硬膜外镇痛而无皮下 CLIA 的患者被分配到对照组。疗效终点包括：（i）术后 24、48、72 小时和 3 个月时的疼痛评分；（ii）术后 24、48、72 小时和 24-72 小时（累积）的阿片类药物消耗量；（iii）住院时间；（iv）术后 3 个月膝关节功能恢复，根据膝关节损伤和骨关节炎结果评分。
在休息和活动时，CLIA 组（n=28）在术后 24、48、72 小时和 3 个月时的术后疼痛评分明显低于非 CLIA 组（n=35）。亚组分析显示，CLIA 组在术后 24 小时和 48 小时时的阿片类药物消耗量明显低于非 CLIA 组。两组在住院时间或术后 3 个月的功能评分方面无差异。两组在术后 30 天内伤口感染、其他感染和再入院率方面无差异。
皮下 CLIA 是一种技术上可行且安全的方法，没有重大不良事件，但可降低术后疼痛评分（在休息和活动时）和阿片类药物消耗。需要更大规模的研究来证实我们的结果。此外，皮下 CLIA 与关节周围或关节内 CLIA 之间的头对头比较是一项有趣的前瞻性研究。
