Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan
Department of Anesthesiology, Kansai Medical University, Hirakata, Osaka, Japan.
Reg Anesth Pain Med. 2023 Aug;48(8):420-424. doi: 10.1136/rapm-2022-104303. Epub 2023 Mar 28.
Perineural catheters placed parallel to the nerve course are reported to have lower migration rates than those placed perpendicular to it. However, catheter migration rates for a continuous adductor canal block (ACB) remain unknown. This study compared postoperative migration rates of proximal ACB catheters placed parallel and perpendicular to the saphenous nerve.
Seventy participants scheduled for unilateral primary total knee arthroplasty were randomly assigned for parallel or perpendicular placement of the ACB catheter. The primary outcome was the migration rate of the ACB catheter on postoperative day (POD) 2. Catheter migration was defined as being unable to confirm saline administration via the catheter around the saphenous nerve at the mid-thigh level under ultrasound guidance. Secondary outcomes included active and passive range of motion (ROM) of the knee on postoperative rehabilitation.
Sixty-seven participants were included in the final analyses. The catheter migrated significantly less often in the parallel group (5 of 34 (14.7%)) than in the perpendicular group (24 of 33 (72.7%)) (p<0.001). The mean (SD) active and passive knee flexion ROM (degrees) improved significantly in the parallel than in the perpendicular group (POD 1: active, 88.4 (13.2) vs 80.0 (12.4), p=0.011; passive, 95.6 (12.8) vs 85.7 (13.6), p=0.004; POD 2: active, 88.7 (13.4) vs 82.2 (11.5), p=0.036; passive, 97.2 (12.8) vs 91.0 (12.0), p=0.045).
Parallel placement of the ACB catheter provided a lower postoperative catheter migration rate than perpendicular placement of the ACB catheter along with corresponding improvements in ROM and secondary analgesic outcomes.
UMIN000045374.
与神经走行平行放置的外周神经导管比与之垂直放置的导管迁移率更低。然而，连续收肌管阻滞（ACB）的导管迁移率仍不清楚。本研究比较了平行和垂直于隐神经放置的近端 ACB 导管在术后的迁移率。
70 名计划行单侧初次全膝关节置换术的患者被随机分为平行或垂直放置 ACB 导管。主要结局是术后第 2 天（POD）ACB 导管的迁移率。导管迁移定义为在超声引导下，在大腿中段无法确认导管周围隐神经处的生理盐水给药。次要结局包括术后康复时膝关节的主动和被动活动范围（ROM）。
67 名参与者纳入最终分析。与垂直组（24/33，72.7%）相比，平行组（5/34，14.7%）的导管迁移明显较少（p<0.001）。与垂直组相比，平行组的膝关节主动和被动屈曲 ROM（度）显著改善（POD1：主动，88.4（13.2）比 80.0（12.4），p=0.011；被动，95.6（12.8）比 85.7（13.6），p=0.004；POD2：主动，88.7（13.4）比 82.2（11.5），p=0.036；被动，97.2（12.8）比 91.0（12.0），p=0.045）。
与 ACB 导管垂直放置相比，ACB 导管平行放置可降低术后导管迁移率，并相应改善 ROM 和次要镇痛结局。
UMIN000045374。
