Knecht Siam, Tamine Lyna, Faure Nicolas, Tran Pierre, Orban Jean-Christophe, Bronsard Nicolas, Gonzalez Jean-François, Micicoi Grégoire
Aix-Marseille University, CNRS, EFS, ADES, 13007 Marseille, France.
University Institute for Locomotion and Sports (IULS), Pasteur 2 Hospital, CHU de Nice, 30 voie Romaine, 06000 Nice, France.
Orthop Traumatol Surg Res. 2025 Sep;111(5):104082. doi: 10.1016/j.otsr.2024.104082. Epub 2024 Dec 5.
Perioperative analgesia after total knee arthroplasty (TKA) reduces morphine consumption and speeds up rehabilitation. The primary objective of this study was to compare the pain experienced by patients with an adductor canal and posterior capsule block with those with a continuous femoral nerve block combined with a popliteal sciatic nerve block. The secondary objectives were to analyze the time to recovery from early walking, length of hospital stay, and block-related complications between the two groups.
Patients with an adductor canal block and posterior capsular infiltration had less pain 24 h after TKA.
This single-center retrospective study included 774 TKA between January 2020 and March 2023. Two types of locoregional blocks were evaluated: patients who had a continuous femoral nerve block with a single-shot popliteal sciatic nerve block (FN-PSN group) operated on before March 2022 and those who had a single-shot adductor canal block combined with posterior capsular infiltration (ACB-PI group) operated on after March 2022. One patient in the ACB-PI group was matched to two patients in the NF-BS group according to sex, age, and BMI. A total of 725 TKA were included: 500 in the FN-PSN group and 225 in the ACB-PI group. The primary endpoint was pain assessed using the numerical pain rating scale (NPRS) and opioid consumption at 24 h after TKA. Resumption of walking, defined as getting up for the first time and walking ten steps until discharge from the hospital, and complications between the two groups were also assessed. The study population consisted of 471 women (64.9%) with a mean age of 72.2 ± 8.2 years and a mean BMI of 28.2 ± 4.6.
Patients in the FN-PSN group had less pain at NPRS (1.3 versus 1.9; p < 0.001), and fewer patients required morphine titration (13.8% versus 6.8%, p = 0.02) within the first 8 h of surgery with no difference at 24 h, 48 h and 72 h. The mean doses of morphine administered were similar between the groups. Resumption of walking was significantly longer in the FN-PSN group (1.5 versus 2.0 days, p = 0.003), and hospitalization times and complications were similar between the groups.
Adductor canal block combined with posterior capsular infiltration did not reduce postoperative pain compared with femoral and popliteal sciatic block at 24 h after TKA. Opioid consumption and pain were similar between the groups, with more patients requiring morphine in the first eight hours in the ACB-PI group but with a faster return to walking.
III; comparative study.
全膝关节置换术（TKA）后的围手术期镇痛可减少吗啡用量并加速康复。本研究的主要目的是比较接受收肌管和后关节囊阻滞的患者与接受连续股神经阻滞联合腘坐骨神经阻滞的患者所经历的疼痛。次要目的是分析两组患者从早期步行恢复的时间、住院时间以及与阻滞相关的并发症。
接受收肌管阻滞和后关节囊浸润的患者在TKA后24小时疼痛较轻。
这项单中心回顾性研究纳入了2020年1月至2023年3月期间的774例TKA。评估了两种局部阻滞类型：2022年3月之前接受连续股神经阻滞加单次腘坐骨神经阻滞的患者（FN-PSN组）和2022年3月之后接受单次收肌管阻滞联合后关节囊浸润的患者（ACB-PI组）。根据性别、年龄和BMI，将ACB-PI组的1例患者与FN-BS组的2例患者进行匹配。总共纳入了725例TKA：FN-PSN组500例，ACB-PI组225例。主要终点是使用数字疼痛评分量表（NPRS）评估的疼痛以及TKA后24小时的阿片类药物用量。还评估了两组患者的步行恢复情况（定义为首次起床并行走十步直至出院）和并发症。研究人群包括471名女性（64.9%），平均年龄为72.2±8.2岁，平均BMI为28.2±4.6。
FN-PSN组患者的NPRS疼痛评分较低（1.3对1.9；p<0.001），并且在手术的前8小时内需要吗啡滴定的患者较少（13.8%对6.8%，p = 0.02），但在24小时、48小时和72小时时无差异。两组之间给予的吗啡平均剂量相似。FN-PSN组的步行恢复时间明显更长（1.5天对2.0天，p = 0.003），两组之间的住院时间和并发症相似。
与TKA后24小时的股神经和腘坐骨神经阻滞相比，收肌管阻滞联合后关节囊浸润并没有减轻术后疼痛。两组之间的阿片类药物用量和疼痛相似，ACB-PI组在前八小时内需要吗啡的患者更多，但步行恢复更快。
III；比较研究。
