Department of Orthopaedic Surgery, Institute for Orthopaedics & Neurosciences, Carilion Clinic, Roanoke, Virginia; Department of Orthopaedic Surgery, Larkin Community Hospital, Miami, Florida.
Department of Orthopaedic Surgery, Institute for Orthopaedics & Neurosciences, Carilion Clinic, Roanoke, Virginia.
J Arthroplasty. 2024 Aug;39(8S1):S120-S124. doi: 10.1016/j.arth.2024.03.064. Epub 2024 Apr 9.
The shift toward outpatient total knee arthroplasties (TKAs) has led to a demand for effective perioperative pain control methods. A surgeon-performed "low" adductor canal block ("low-ACB") technique, involving an intraoperative ACB, is gaining popularity due to its efficiency and early pain control potential. This study examined the transition from traditional preoperative anesthesiologist-performed ultrasound-guided adductor canal blocks ("high-ACB") to low-ACB, evaluating pain control, morphine consumption, first physical therapy visit gait distance, hospital length-of-stay, and complications.
There were 2,620 patients at a single institution who underwent a primary total knee arthroplasty between January 1, 2019, and December 31, 2022, and received either a low-ACB or high-ACB. Cohorts included 1,248 patients and 1,372 patients in the low-ACB and high-ACB groups, respectively. Demographics and operative times were similar. Patient characteristics and outcomes such as morphine milligram equivalents (MMEs), Visual Analog Scale pain scores, gait distance (feet), length of stay (days), and postoperative complications (30-day readmission and 30-day emergency department visit) were collected.
The low-ACB cohort had higher pain scores over the first 24 hours (5.05 versus 4.86, P < .001) and higher MME at 6 hours (11.49 versus 8.99, P < .001), although this was not clinically significant. There was no difference in pain scores or MME at 12 or 24 hours (20.81 versus 22.07 and 44.67 versus 48.78, respectively). The low-ACB cohort showed longer gait distance at the first physical therapy visit (188.5 versus 165.1 feet, P < .001) and a shorter length of stay (0.88 versus 1.46 days, P < .01), but these were not clinically significant. There were no differences in 30-day complications.
The low-ACB offers effective pain relief and comparable early recovery without increasing operative time or the complication rate. Low-ACB is an effective, safe, and economical alternative to high-ACB.
Therapeutic study, Level III (retrospective cohort study).
向门诊全膝关节置换术（TKA）的转变导致了对有效围手术期疼痛控制方法的需求。一种由外科医生进行的“低位”收肌管阻滞（“低位 ACB”）技术，涉及术中 ACB，由于其效率和早期疼痛控制潜力而越来越受欢迎。本研究考察了从传统的术前麻醉师进行的超声引导收肌管阻滞（“高位 ACB”）向低位 ACB 的转变，评估了疼痛控制、吗啡消耗、第一次物理治疗就诊时的步态距离、住院时间和并发症。
在一家机构中，有 2620 名患者在 2019 年 1 月 1 日至 2022 年 12 月 31 日期间接受了初次全膝关节置换术，并接受了低位 ACB 或高位 ACB。队列包括低位 ACB 组的 1248 名患者和高位 ACB 组的 1372 名患者。手术时间和患者特征相似。收集了吗啡毫克当量（MME）、视觉模拟评分疼痛评分、步态距离（英尺）、住院时间（天）和术后并发症（30 天再入院和 30 天急诊就诊）等患者特征和结果。
低位 ACB 组在最初 24 小时的疼痛评分更高（5.05 对 4.86，P <.001），6 小时的 MME 更高（11.49 对 8.99，P <.001），尽管这没有临床意义。在 12 小时或 24 小时时，疼痛评分或 MME 没有差异（分别为 20.81 对 22.07 和 44.67 对 48.78）。低位 ACB 组在第一次物理治疗就诊时的步态距离更长（188.5 对 165.1 英尺，P <.001），住院时间更短（0.88 对 1.46 天，P <.01），但这些没有临床意义。30 天并发症无差异。
低位 ACB 提供了有效的疼痛缓解，并且可以早期恢复，而不会增加手术时间或并发症发生率。低位 ACB 是一种有效、安全且经济的高位 ACB 替代方法。
治疗研究，III 级（回顾性队列研究）。
