Mira-Puerto Alejandra, Romero-Aroca Pedro, Rodríguez-Gangoso Alfredo, Ferrando-de Jorge Albert, Duart-Oltra Mireia, Sala-Francino Pilar, Martínez-Segovia Mari Carmen, Baget-Bernaldiz Marc
Anaesthetic Service, Hospital Universitat Sant Joan, Institut d'Investigació Sanitària Pere Virgili [IISPV], Universitat Rovira i Virgili, 43204 Reus, Spain.
Ophthalmology Service, Hospital Universitat Sant Joan, Institut d'Investigació Sanitària Pere Virgili [IISPV], Universitat Rovira i Virgili, 43204 Reus, Spain.
J Clin Med. 2024 Jul 26;13(15):4387. doi: 10.3390/jcm13154387.
: The aim of this study was to compare the postoperative analgesic efficacy when a tibial nerve block was added to the femoral nerve block for total knee arthroplasty (TKA). : A total of 60 patients were randomly assigned to the experimental group (EG) or the control group (CG) in a 1:1 ratio. The thirty patients who formed the CG underwent an ultrasound-guided femoral nerve block together with neuraxial anaesthesia and the administration of opioids and NSAIDs through an intravenous elastomeric pump for the management of the postoperative pain; the other thirty, who formed the EG, underwent neuraxial anaesthesia together with femoral and tibial nerve blocks. The efficacy of the analgesic effect was evaluated based on the numerical pain rating scale (NPRS) and on the need for analgesic rescue at different time intervals within 48 h after surgery. : At 24 h, the mean NPRS score in the EG and CG at rest was 1.50 ± 1.19 and 1.63 ± 1.60 [ = 443.5, = 0.113], respectively. With joint movement, the mean NPRS score was 2.80 ± 1.49 and 3.57 ± 1.79 [ = 345, = 0.113], respectively. Ten patients in the EG [33.3%] and 24 in the CG [80%] required rescue analgesia [Phi = 0.471, < 0.001]. At 48 h, the mean NPRS score in the EG and CG at rest was 0.33 ± 0.60 and 0.43 ± 0.72 [ = 428, = 0.681], respectively. With movement, the mean NPRS score was 1.03 ± 0.99 in the EG and 1.60 ± 1.07 in the CG [ = 315, = 0.038]. No patient in the EG group required rescue analgesia, while three patients in the CG [10%] did [Phi = 0.229, = 0.076]. The mean opioid dosage in the CG was 300 mg, whereas in the EG it was 40 mg ± 62.14 [ < 0.05, < 0.001]. : Adding a tibial nerve block to the femoral nerve block in TKA may achieve the same analgesic efficacy within 48 h after surgery and would reduce the systematic use of opioids.
本研究的目的是比较在全膝关节置换术（TKA）中，在股神经阻滞基础上加用胫神经阻滞的术后镇痛效果。
总共60例患者按1:1比例随机分为实验组（EG）和对照组（CG）。组成CG的30例患者接受超声引导下股神经阻滞，同时联合椎管内麻醉，并通过静脉弹性泵给予阿片类药物和非甾体抗炎药以管理术后疼痛；组成EG的另外30例患者接受椎管内麻醉，同时联合股神经和胫神经阻滞。根据数字疼痛评分量表（NPRS）以及术后48小时内不同时间间隔的镇痛补救需求来评估镇痛效果。
在24小时时，EG组和CG组静息时的平均NPRS评分分别为1.50±1.19和1.63±1.60[χ² = 443.5，P = 0.113]。关节活动时，平均NPRS评分分别为2.80±1.49和3.57±1.79[χ² = 345，P = 0.113]。EG组有10例患者[33.3%]需要补救镇痛，CG组有24例患者[80%]需要补救镇痛[φ = 0.471，P < 0.001]。在48小时时，EG组和CG组静息时的平均NPRS评分分别为0.33±0.60和0.43±0.72[χ² = 428，P = 0.681]。活动时，EG组的平均NPRS评分为1.03±0.99，CG组为1.60±1.07[χ² = 315，P = 0.038]。EG组无患者需要补救镇痛，而CG组有3例患者[10%]需要补救镇痛[φ = 0.229，P = 0.076]。CG组的平均阿片类药物用量为300毫克，而EG组为40毫克±62.14[P < 0.05，P < 0.001]。
在TKA中，在股神经阻滞基础上加用胫神经阻滞在术后48小时内可达到相同的镇痛效果，并可减少阿片类药物的全身使用。
