Department of Anesthesiology, Flinders Medical Centre, Flinders Drive, Bedford Park Adelaide, South Australia, 5042, Australia.
College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
BMC Anesthesiol. 2024 Oct 10;24(1):365. doi: 10.1186/s12871-024-02740-1.
Finding the balance of good postoperative analgesia while facilitiating mobility is important for a safe and satisfactory patient experience during Total Knee Arthroplasty (TKA). This study aimed to compare the efficacy of intrathecal morphine, adductor canal block, and their combination in optimizing pain management and postoperative recovery in TKA patients. This retrospective analysis of prospectively collected data evaluated postoperative pain scores, time to mobilisation, and length of hospital stay.
1006 consecutive patients undergoing elective TKA across two large tertiary centres were included over six years. They were divided into one of four groups according to the type of analgesia received: Group N patients received no neuraxial morphine or regional block. Group B patients received adductor canal block (ACB) only. Group M patients received intrathecal morphine (ITM) but no regional block. Group BM patients received both ACB and ITM.
Patients who received an ACB had faster postoperative mobilization compared to those without (p < 0.001). Patients in Group BM had the lowest pain scores at rest (Visual Analogue Scale (VAS) 2.9) and with movement (VAS 5.3), while Group B patients experienced the highest pain scores at rest (VAS 3.7) and on movement (VAS 6.5) (p = 0.005). Patients who received ITM had the lowest opioid requirements (p < 0.001). There was no significant differences between groups in requirement for rescue pain management strategies (p = 0.06).
The combination of ITM and ACB in patients undergoing TKA provides improved postoperative analgesia with lower postoperative opioid requirement and earlier mobilization compared with ACB or ITM alone.
在全膝关节置换术（TKA）期间，找到良好的术后镇痛平衡，同时促进活动能力，对于确保患者安全和满意度非常重要。本研究旨在比较鞘内吗啡、收肌管阻滞及其联合应用在优化 TKA 患者疼痛管理和术后恢复方面的效果。这项前瞻性收集数据的回顾性分析评估了术后疼痛评分、活动时间和住院时间。
在六年期间，两个大型三级中心共纳入了 1006 例接受择期 TKA 的连续患者。根据接受的镇痛类型将他们分为四组之一：N 组患者未接受鞘内吗啡或区域阻滞。B 组患者仅接受收肌管阻滞（ACB）。M 组患者接受鞘内吗啡（ITM）但未接受区域阻滞。BM 组患者接受 ACB 和 ITM。
接受 ACB 的患者术后活动更快（p<0.001）。与未接受 ACB 的患者相比，BM 组患者的静息时疼痛评分最低（视觉模拟评分（VAS）2.9），活动时疼痛评分也最低（VAS 5.3），而 B 组患者静息时疼痛评分最高（VAS 3.7），活动时疼痛评分也最高（VAS 6.5）（p=0.005）。接受 ITM 的患者需要的阿片类药物最少（p<0.001）。各组之间对挽救性疼痛管理策略的需求没有显著差异（p=0.06）。
与单独使用 ACB 或 ITM 相比，在接受 TKA 的患者中联合使用 ITM 和 ACB 可提供更好的术后镇痛效果，术后阿片类药物需求更低，活动更早。
