Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Curr Opin Anaesthesiol. 2023 Oct 1;36(5):541-546. doi: 10.1097/ACO.0000000000001287. Epub 2023 Jun 23.
To summarize the recent literature describing and comparing novel motor-sparing peripheral nerve block techniques for hip and knee surgery. This topic is relevant because the number of patients undergoing same day discharge after hip and knee surgery is increasing. Preserving lower extremity muscle function is essential to facilitate early physical therapy for these patients.
Distal peripheral nerve blocks may allow for preserved quadriceps motor strength and comparable analgesia to traditional techniques. However, few studies in hip and knee populations include strength or function as primary outcomes. For hip surgeries, studies have failed to show analgesic differences between regional blocks and periarticular infiltration. Similarly for knee arthroplasty in the absence of periarticular infiltration, recent evidence suggests adding combinations of blocks (ACB plus iPACK or genicular nerve blocks) may balance pain control and early ambulation.
The use of motor-sparing peripheral nerve block techniques enables early ambulation, adequate pain control, and avoidance of opioid-related side effects facilitating outpatient/ambulatory lower extremity surgery. Further studies of these techniques for continuous peripheral nerve block catheters are needed to assess if extended blockade continues to provide motor-sparing and opioid-sparing benefits.
描述和比较用于髋膝关节手术的新型保留运动神经的外周神经阻滞技术的最新文献。这一主题很重要，因为越来越多的髋膝关节手术后患者需要当天出院。保留下肢肌肉功能对于这些患者早期进行物理治疗至关重要。
远端外周神经阻滞可能使股四头肌肌力保持不变，并提供与传统技术相当的镇痛效果。然而，很少有研究将力量或功能作为髋膝关节人群的主要结局。对于髋关节手术，研究未能显示区域阻滞和关节周围浸润之间的镇痛差异。同样，对于膝关节置换术，如果没有关节周围浸润，最近的证据表明添加阻滞组合（ACB 加 iPACK 或膝神经阻滞）可能平衡疼痛控制和早期活动。
使用保留运动神经的外周神经阻滞技术可以实现早期活动、充分的疼痛控制和避免阿片类药物相关的副作用，从而促进门诊/日间下肢手术。需要进一步研究这些技术在连续外周神经阻滞导管中的应用，以评估延长阻滞是否继续提供保留运动和减少阿片类药物的益处。
