Department of Orthopedics and Traumatology, Kirsehir Ahi Evran University, Kirsehir, Turkey.
Department of Anesthesiology, Kirsehir Ahi Evran University, Kirsehir, Turkey.
BMC Musculoskelet Disord. 2024 Aug 10;25(1):637. doi: 10.1186/s12891-024-07762-x.
Adductor canal block (ACB) is widely performed for postoperative analgesia for total knee arthroplasty (TKA). The aim of this study is to compare surgeon-assisted and anesthesiologist-assisted (ultrasound-guided) adductor blocks in terms of postoperative analgesic efficacy.
This study was designed as a double-blind, prospective and randomized trial. A total of 240 participants were randomly allocated to three groups: one where the surgeon performed the adductor canal block (ACBs), another where it was conducted by an anesthetist with ultrasound guidance (ACBa), and a third group without the adductor block. The follow-up management after the Total Knee Arthroplasty (TKA) procedure occurred on the first, third, and tenth days, as well as the twelfth week. Outcome measures comprised pain assessment using the Visual Analog Scale (VAS) and monitoring opioid analgesic consumption.
No significant differences in demographic profiles were observed between the groups. Groups ACBa and ACBs exhibited significantly lower VAS scores compared to the control group at both 3 and 12 h after surgery, with group ACBa showing the lowest VAS scores among all groups. However, at 1 day, 3 days, 10 days and 12 weeks after surgery, there was no significant difference in VAS scores between the ACBa and ACBs groups. On the first three days, the ACBa group had the lowest opioid consumption and the lowest total opioid consumption. The differences in VAS scores between the groups began to decrease on the first day after surgery.
The adductor canal block (ACB) has been demonstrated to be an effective method of reducing pain in patients undergoing total knee replacement (TKR) in the postoperative period. Nevertheless, despite the pronounced impact that ACB performed by an anesthesiologist under ultrasound guidance has on VAS scores according to intraoperative ACB by surgeons, its effect on clinical outcomes has not been demonstrated.
This study was retrospectively registered with the Clinical Trials Registry Platform on July 31, 2024 (NCT06533085).
股管阻滞（ACB）广泛应用于全膝关节置换术（TKA）术后镇痛。本研究旨在比较外科医生辅助和麻醉师辅助（超声引导）股管阻滞在术后镇痛效果方面的差异。
本研究设计为双盲、前瞻性、随机临床试验。共 240 名参与者被随机分配到三组：一组由外科医生进行股管阻滞（ACB），另一组由麻醉师行超声引导下股管阻滞（ACBa），第三组不进行股管阻滞。TKA 术后第 1、3、10 天及第 12 周进行随访管理。主要结局指标为采用视觉模拟评分（VAS）评估疼痛，并监测阿片类镇痛药的使用。
各组之间的人口统计学特征无显著差异。与对照组相比，ACBa 和 ACBs 组在术后 3 和 12 小时的 VAS 评分显著降低，其中 ACBa 组的 VAS 评分最低。然而，在术后 1 天、3 天、10 天和 12 周时，ACBa 和 ACBs 组之间的 VAS 评分无显著差异。在术后前 3 天，ACBa 组的阿片类药物消耗量最低，总阿片类药物消耗量最低。各组之间的 VAS 评分差异在术后第 1 天开始减小。
股管阻滞（ACB）可有效减轻全膝关节置换术（TKR）患者术后疼痛。然而，尽管超声引导下麻醉师进行的 ACB 对 VAS 评分的影响明显大于外科医生术中进行的 ACB，但并未显示其对临床结局的影响。
本研究于 2024 年 7 月 31 日在临床试验注册平台上进行了回顾性注册（NCT06533085）。
