全膝关节置换术中连续收肌管阻滞与硬膜外麻醉的比较。
Continuous Adductor Canal Block Compared to Epidural Anesthesia for Total Knee Arthroplasty.
作者信息
Freedman Isaac G, Mercier Michael R, Galivanche Anoop R, Sandhu Mani Ratnesh S, Hocevar Mark, Moore Harold Gregory, Grauer Jonathan N, Rubin Lee E, Li Jinlei
机构信息
Department of Anesthesiology, Critical Care & Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA.
出版信息
J Pain Res. 2024 Nov 13;17:3729-3740. doi: 10.2147/JPR.S462079. eCollection 2024.
AIM
To compare the efficacy of a postoperative continuous adductor canal block (cACB) with and without a steroid adjuvant to that of epidural analgesia (EA).
METHODS
Patients who underwent primary total TKA at a single institution between July 2011-November 2017 were included for retrospective analysis. TKA patients were stratified into one of the three analgesia approaches: EA, cACB without steroid adjuvant, and cACB with steroid adjuvant. Hospital length of stay (LOS), discharge disposition, incidence of postoperative adverse events, and total milligram morphine equivalents (MME) requirements were compared between strata. Logistic regressions were performed to assess the independent effect of analgesia approach on prolonged LOS greater than 3 days (pLOS), non-home discharge, and total and daily MME requirements (tMME and dMME) following TKA.
RESULTS
Of the 4345 patients undergoing TKA, 1556 (35.83%) received EA, 2087 (48.03%) received cACB without steroids, and 702 (16.13%) cACB with steroids. cACB patients experienced lower rates of pLOS, higher rates of discharge to home than EA patients, and lower tMME and dMME. On multivariable analysis, cACB groups were at a lower odds of experiencing a pLOS compared to EA patients without steroids (OR = 0.64; 95% CI 0.49-0.84; with steroids: OR = 0.54; 95% CI 0.38-0.76). cACB groups had lower odds of a non-home discharge when compared to EA patients (without steroids OR = 0.42; 95% CI 0.36-0.48; with steroids: OR 0.22; 95% CI 0.18-0.27). On multivariable analysis, cACB groups required less tMME compared to the EA group (without steroids β=-290 mmE; 95% CI: -313 to -268 mmE; with steroids: β=-261 mmE; 95% CI: -289 to -233 mmE) as well as lower dMME (without steroids: β=-66 mmE/day; 95% CI -72 to -60 mmE/day; with steroids: β=-48 mmE/day; 95% CI -55 to -40 mmE/day).
CONCLUSION
cACB was associated with greater discharge to home rates, lower rates of pLOS, and lower tMME and dMME consumption.
LEVEL OF EVIDENCE
Level III.
目的
比较术后连续收肌管阻滞（cACB）加用与不加用类固醇佐剂与硬膜外镇痛（EA）的疗效。
方法
纳入2011年7月至2017年11月在单一机构接受初次全膝关节置换术（TKA）的患者进行回顾性分析。TKA患者被分为三种镇痛方法之一：EA、不加类固醇佐剂的cACB和加类固醇佐剂的cACB。比较各层之间的住院时间（LOS）、出院处置、术后不良事件发生率和吗啡当量（MME）总量需求。进行逻辑回归分析，以评估镇痛方法对TKA术后LOS延长超过3天（pLOS）、非家庭出院以及MME总量和每日需求（tMME和dMME）的独立影响。
结果
在4345例行TKA的患者中，1556例（35.83%）接受EA，2087例（48.03%）接受不加类固醇的cACB，702例（16.13%）接受加类固醇的cACB。与EA患者相比，cACB患者的pLOS发生率较低，回家出院率较高，tMME和dMME较低。多变量分析显示，与未使用类固醇的EA患者相比，cACB组发生pLOS的几率较低（OR = 0.64；95% CI 0.49 - 0.84；使用类固醇：OR = 0.54；95% CI 0.38 - 0.76）。与EA患者相比，cACB组非家庭出院的几率较低（未使用类固醇OR = 0.42；95% CI 0.36 - 0.48；使用类固醇：OR 0.22；95% CI 0.18 - 0.27）。多变量分析显示，与EA组相比，cACB组所需的tMME较少（未使用类固醇β=-290 mmE；95% CI：-313至-268 mmE；使用类固醇：β=-261 mmE；95% CI：-289至-233 mmE），dMME也较低（未使用类固醇：β=-66 mmE/天；95% CI -72至-60 mmE/天；使用类固醇：β=-48 mmE/天；95% CI -55至-40 mmE/天）。
结论
cACB与更高的回家出院率、更低的pLOS发生率以及更低的tMME和dMME消耗量相关。
证据级别
三级。
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