Sumanont Sermsak, Jaruwanneechai Khananut, Wittayapairoj Aumjit, Apiwatanakul Punyawat, Boonrod Artit
Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Thailand.
Srinagarind Minimally Invasive Surgery Center of Excellence, Khon Kaen, Thailand.
Orthop J Sports Med. 2024 Nov 15;12(11):23259671241292604. doi: 10.1177/23259671241292604. eCollection 2024 Nov.
Both adductor canal block (ACB) and local infiltration (LI) are effective for postoperative pain management after arthroscopic-assisted anterior cruciate ligament (ACL) reconstruction (ACLR). While LI is a more straightforward procedure, its effectiveness remains debated.
To evaluate morphine consumption within 48 hours after ACLR with a semitendinosus tendon graft, comparing ACB and LI; secondary objectives: to evaluate pain levels, patient satisfaction, quadriceps strength, range of knee motion, and complications.
Randomized controlled trial; Level of evidence, 1.
Patients undergoing primary ACLR with a semitendinosus tendon graft were randomized to receive either ACB (0.25% bupivacaine; 20 mL) or LI at the surgical wound, graft harvest area, and intra-articular injection. The LI group received morphine (3 mg), ketorolac (30 mg), and tranexamic acid (1 g). Morphine consumption within 48 hours was monitored using an intravenous patient-controlled analgesia device.
A total of 48 patients were analyzed (n = 24 in each group); baseline characteristics were similar between groups. The LI group consumed significantly less morphine than the ACB group at 6 hours (median [interquartile range, IQR], 3 mg [0-4.8 mg] for the LI group vs 5.5 mg [2-9] for the ACB group; = .003). However, no significant differences were observed in morphine consumption at other time points. Additionally, no significant difference was found in cumulative morphine consumption at 48 hours between the groups (median [IQR], 21.5 mg [11-34.5 mg] for the ACB group vs 16.5 mg [8.5-21.8 mg] for the LI group; = .137). Postoperative pain scores, quadriceps strength, and patient satisfaction were similar between the 2 groups.
Morphine consumption at 48 hours postoperatively was comparable between the LI and ACB groups, and no significant group differences were found in postoperative pain, quadriceps strength, or patient satisfaction.
TCTR20190320003 (Thai Clinical Trial Registry).
内收肌管阻滞（ACB）和局部浸润（LI）对关节镜辅助下前交叉韧带（ACL）重建（ACLR）术后的疼痛管理均有效。虽然LI是一种更直接的操作，但其有效性仍存在争议。
比较ACB和LI，评估半腱肌肌腱移植ACLR术后48小时内的吗啡消耗量；次要目标：评估疼痛程度、患者满意度、股四头肌力量、膝关节活动范围和并发症。
随机对照试验；证据等级，1级。
接受半腱肌肌腱移植初次ACLR的患者被随机分为接受ACB（0.25%布比卡因；20 mL）或在手术切口、移植物取材部位和关节内注射处进行LI。LI组接受吗啡（3 mg）、酮咯酸（30 mg）和氨甲环酸（1 g）。使用静脉自控镇痛装置监测48小时内的吗啡消耗量。
共分析了48例患者（每组n = 24）；两组间基线特征相似。LI组在6小时时的吗啡消耗量显著低于ACB组（中位数[四分位间距，IQR]，LI组为3 mg[0 - 4.8 mg]，ACB组为5.5 mg[2 - 9]；P = .003）。然而，在其他时间点的吗啡消耗量未观察到显著差异。此外，两组在48小时时的累积吗啡消耗量也无显著差异（中位数[IQR]，ACB组为21.5 mg[11 - 34.5 mg]，LI组为16.5 mg[8.5 - 21.8 mg]；P = .137）。两组术后疼痛评分、股四头肌力量和患者满意度相似。
LI组和ACB组术后48小时的吗啡消耗量相当，术后疼痛、股四头肌力量或患者满意度方面两组无显著差异。
TCTR20190320003（泰国临床试验注册中心）
