Shoni Melina, Samineni Aneesh V, Salavati Seroos, Mikkilineni Nikhil, Wang Allen, Abdeen Ayesha, Freccero David
Department of Anesthesiology, Boston Medical Center, Boston, MA, USA.
Department of Orthopaedic Surgery, University of Miami Hospital, Miami, FL, USA.
Arthroplast Today. 2023 Dec 28;25:101292. doi: 10.1016/j.artd.2023.101292. eCollection 2024 Feb.
To investigate if combined single-shot adductor canal blockade (ACB) and infiltration between the popliteal artery and capsule of the knee (IPACK) provide better postoperative pain management compared to ACB alone for patients undergoing unilateral total knee arthroplasty (TKA).
This retrospective cohort study included adult patients who underwent primary, unilateral TKA. Patients were separated into 2 cohorts: single-shot ACB alone (performed with bupivacaine 0.25%) and combined single-shot ACB + IPACK (performed with bupivacaine 0.25%, dexmedetomidine 1 mg/kg, and dexamethasone 4 mg). Patients were propensity-matched 1:1. The primary study outcome was total opioid consumption converted to morphine milligram equivalents (MME) per eight-hour interval and postoperative day. Secondary outcomes included pain scores, length of stay, ambulation distance, return to emergency department, hospital readmission, and 30-day adverse events.
One hundred eighty patients were identified, of which propensity matching used 71% to yield 64 patients receiving ACB alone and 64 receiving combined ACB + IPACK. Combined ACB + IPACK had significantly lower total summative MME throughout the entire postoperative stay ( = .002) and cumulatively after the first 24 hours ( < .001). Combined ACB + IPACK also had lower mean pain scores for 0-8 hours ( = .005) and 8-16 hours ( = .009) postoperatively. There were no significant differences in secondary outcomes.
Combined single-shot ACB + IPACK block was associated with lower total narcotic intake and mean pain scores during most of the immediate postoperative period following primary, unilateral TKA compared to ACB alone. Implementing longer-acting, single-shot ACB + IPACK for TKA can balance effective and more selective pain management with early rehabilitation.
探讨对于接受单侧全膝关节置换术（TKA）的患者，单次股内收肌管阻滞（ACB）联合腘动脉与膝关节囊间浸润（IPACK）与单纯ACB相比，是否能提供更好的术后疼痛管理。
这项回顾性队列研究纳入了接受初次单侧TKA的成年患者。患者被分为2组：单纯单次ACB（使用0.25%布比卡因）和联合单次ACB + IPACK（使用0.25%布比卡因、1 mg/kg右美托咪定和4 mg地塞米松）。患者按1:1倾向评分匹配。主要研究结局是每8小时间隔和术后天数转换为吗啡毫克当量（MME）的总阿片类药物消耗量。次要结局包括疼痛评分、住院时间、行走距离、返回急诊科情况、再次入院以及30天不良事件。
共识别出180例患者，其中倾向评分匹配使用了71%，产生64例仅接受ACB的患者和64例接受联合ACB + IPACK的患者。联合ACB + IPACK在整个术后住院期间的总累计MME显著更低（P = 0.002），且在最初24小时后累计更低（P < 0.001）。联合ACB + IPACK术后0 - 8小时（P = 0.005）和8 - 十六小时（P = 0.009）的平均疼痛评分也更低。次要结局无显著差异。
与单纯ACB相比，在初次单侧TKA后的大部分术后即刻期间，联合单次ACB + IPACK阻滞与更低的总麻醉剂摄入量和平均疼痛评分相关。对TKA实施长效单次ACB + IPACK可在早期康复的同时平衡有效且更具选择性的疼痛管理。
