Gong Jinyan, Tang Lu, Han Yuyu, Liu Pengcheng, Yu Xue, Wang Fei
Shandong University of Traditional Chinese Medicine, Jinan, China.
Department of Anesthesiology, the 960th hospital of People's Liberation Army of China (PLA), Jinan, China.
PLoS One. 2024 Aug 1;19(8):e0306249. doi: 10.1371/journal.pone.0306249. eCollection 2024.
Continuous adductor canal block (CACB) is almost a pure sensory nerve block and can provide effective analgesia without blocking the motor branch of the femoral nerve. Thus, the objective of this study was to systematically evaluate the efficacy of CACB versus continuous femoral nerve block (CFNB) on analgesia and functional activities in patients undergoing knee arthroplasty. PubMed, Embase and the Cochrane Central Register of Controlled Trials (from inception to 3 October 2023) were searched for randomized controlled trials (RCTs) that compared CACB with CFNB in patients undergoing knee arthroplasty. Registration in the PROSPERO International prospective register of the meta-analysis was completed, prior to initiation of the study (registration number: CRD42022363756). Two independent reviewers selected the studies, extracted data and evaluated risk of bias by quality assessment. Revman 5.4 software was used for meta-analysis and the summary effect measure were calculated by mean differences and 95% confidence intervals. Eleven studies with a total of 748 patients were finally included. Pooled analysis suggested that both CACB and CFNB showed the same degree of pain relief at rest and at motion at 12 h, 24 h and 48 h in patients undergoing knee arthroplasty. Compared with CFNB, CACB preserved the quadriceps muscle strength better (P<0.05) and significantly shortened the discharge readiness time (P<0.05). In addition, there was no significant difference in opioid consumption, knee extension and flexion, timed up and go (TUG) test, or risk of falls between the two groups. Thus, Compared with CFNB, CACB has similar effects on pain relief both at rest and at motion and opioid consumption for patients undergoing knee arthroplasty, while CACB is better than CFNB in preserving quadriceps muscle strength and shortening the discharge readiness time.
连续收肌管阻滞（CACB）几乎是一种单纯的感觉神经阻滞，可提供有效的镇痛效果而不阻滞股神经的运动分支。因此，本研究的目的是系统评价CACB与连续股神经阻滞（CFNB）对膝关节置换术患者镇痛及功能活动的疗效。检索了PubMed、Embase和Cochrane对照试验中心注册库（从建库至2023年10月3日），以查找比较膝关节置换术患者中CACB与CFNB的随机对照试验（RCT）。在研究开始前完成了在PROSPERO国际荟萃分析前瞻性注册库中的注册（注册号：CRD42022363756）。两名独立的审阅者选择研究、提取数据并通过质量评估评估偏倚风险。使用Revman 5.4软件进行荟萃分析，并通过均值差异和95%置信区间计算汇总效应量。最终纳入了11项研究，共748例患者。汇总分析表明，在膝关节置换术患者中，CACB和CFNB在12小时、24小时和48小时的静息和运动时疼痛缓解程度相同。与CFNB相比，CACB能更好地保留股四头肌力量（P<0.05），并显著缩短出院准备时间（P<0.05）。此外，两组在阿片类药物消耗量、膝关节屈伸、计时起立行走（TUG）试验或跌倒风险方面无显著差异。因此，与CFNB相比，CACB对膝关节置换术患者的静息和运动时疼痛缓解及阿片类药物消耗量有相似的效果，而CACB在保留股四头肌力量和缩短出院准备时间方面优于CFNB。
