Gui Yong-Kang, Xiao Rui, Luo Ya-Ru, Liu Yang, Da Xin, Zhu Si-Hui, Shi De-Wen, Hu Xu-Dong, Xu Guang-Hong
Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, People's Republic of China.
Key Laboratory of Anesthesia and Perioperative Medicine of Anhui Higher Education Institutes, Hefei, Anhui, 230022, People's Republic of China.
Local Reg Anesth. 2023 Dec 22;16:183-192. doi: 10.2147/LRA.S436767. eCollection 2023.
Pain after total knee arthroplasty (TKA) remains an unresolved problem. Femoral nerve block (FNB) could relieve pain; however, it alone is insufficient. The local infiltration anesthesia technique (LIA) has been suggested as a supplement to FNB. This study aimed to evaluate the analgesic effects of different LIA combined with FNB in TKA patients.
The femoral nerve was blocked with 0.375% ropivacaine 20mL, and all patients routinely received general anesthesia. The primary indicator was the proportion of patients who did not receive post-operative remedial analgesia. Seventy-eight patients were randomly assigned to PAI (periarticular injection combined with FNB), IAI (intra-articular injection combined with FNB), or control (FNB alone) groups. All patients underwent FNB under general anesthesia. The primary outcome was the proportion of patients who did not receive additional postoperative analgesia within the first 48 h after surgery.
Compared with the PAI and control groups, the IAI group had a higher proportion (69.23%) of patients who did not receive remedial analgesia within 48 hours after surgery ( = 0.009; = 0.009), a lower consumption of diclofenac sodium lidocaine ( = 0.021; < 0.001), and an earlier time of walking with a walker ( < 0.001; < 0.001). The time of first need for remedial analgesia postoperatively in IAI group was longer than the PAI group ( = 0.008) and IAI group has a shorter hospital stay than the control group ( = 0.008). The maximum NRS during the first 48 hours postoperatively and NRS 24 hours after surgery in the IAI group were lower than those in the control and PAI groups. The incidences of POD and PONV were similar among the three groups ( = 0.610; = 0.264).
When combined with FNB, intra-articular injection offers a superior analgesic effect and favorable recovery compared to periarticular injection and separate application of FNB.
全膝关节置换术（TKA）后的疼痛仍然是一个未解决的问题。股神经阻滞（FNB）可以缓解疼痛；然而，单独使用它是不够的。局部浸润麻醉技术（LIA）已被建议作为FNB的补充。本研究旨在评估不同LIA联合FNB对TKA患者的镇痛效果。
用20mL 0.375%罗哌卡因阻滞股神经，所有患者均常规接受全身麻醉。主要指标是未接受术后补救镇痛的患者比例。78例患者被随机分为PAI（关节周围注射联合FNB）、IAI（关节内注射联合FNB）或对照组（单纯FNB）。所有患者在全身麻醉下接受FNB。主要结局是术后48小时内未接受额外术后镇痛的患者比例。
与PAI组和对照组相比，IAI组在术后48小时内未接受补救镇痛的患者比例更高（69.23%）（P = 0.009；P = 0.009），双氯芬酸钠利多卡因的消耗量更低（P = 0.021；P < 0.001），使用助行器行走的时间更早（P < 0.001；P < 0.001）。IAI组术后首次需要补救镇痛的时间比PAI组长（P = 0.008），IAI组的住院时间比对照组短（P = 0.008）。IAI组术后48小时内的最大NRS和术后24小时的NRS低于对照组和PAI组。三组的术后谵妄（POD）和恶心呕吐（PONV）发生率相似（P = 0.610；P = 0.264）。
与关节周围注射和单独应用FNB相比，关节内注射联合FNB具有更好的镇痛效果和更有利的恢复。
