Wang Qiuru, Hu Jian, Chen Changjun, Ma Ting, Yang Jing, Kang Pengde
Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
J Bone Joint Surg Am. 2025 Apr 16;107(8):796-804. doi: 10.2106/JBJS.24.00679. Epub 2025 Jan 31.
Whether an adductor canal block (ACB) is more effective when administered before or after total knee arthroplasty (TKA) is unclear. This study compared pain, stress, and functional outcomes between patients who received the block before surgery and those who received the block after surgery.
In this double-blinded trial, 100 patients at our hospital were randomized to receive an ACB at either 30 minutes before general anesthesia or postoperatively in the post-anesthesia care unit (PACU). All patients received periarticular local infiltration analgesia during surgery. The 2 groups were compared with respect to the primary outcome, the postoperative consumption of morphine as rescue analgesia, and in terms of the secondary outcomes, including the time from the end of surgery to the first rescue analgesia or discharge, intraoperative and postoperative stress, postoperative pain, functional recovery, the incidence of chronic pain, and complications.
All included patients were Asian (Chinese) in race/ethnicity. The 2 groups had similar demographic information. Compared with the postoperative ACB, the preoperative ACB was associated with significantly lower morphine consumption within the first 24 hours postoperatively and lower total morphine consumption. It was also associated with a longer time until the first rescue analgesia, lower intraoperative consumption of opioids and inhaled anesthetic, fewer episodes of hypertension during surgery, a lower rate of rescue analgesia in the PACU, lower levels of cortisol and adrenocorticotropic hormone in serum on the morning of postoperative day 1, lower pain on a visual analog scale while at rest or during motion within 12 hours postoperatively, better range of knee motion on postoperative day 1, and a lower incidence of chronic pain at 3 months postoperatively. The 2 groups did not differ significantly with respect to postoperative ambulation distance, time until discharge, or complication rates.
Administering an ACB before rather than after TKA may lead to lower opioid consumption during hospitalization, lower intraoperative and postoperative stress responses, better pain relief during hospitalization, and a lower incidence of chronic pain at 3 months postoperatively.
Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.
内收肌管阻滞（ACB）在全膝关节置换术（TKA）前或后实施时哪种更有效尚不清楚。本研究比较了术前接受阻滞的患者与术后接受阻滞的患者之间的疼痛、应激和功能结局。
在这项双盲试验中，我院100例患者被随机分为在全身麻醉前30分钟或术后在麻醉后护理单元（PACU）接受ACB。所有患者在手术期间均接受关节周围局部浸润镇痛。比较两组的主要结局，即术后吗啡作为补救镇痛的消耗量，以及次要结局，包括从手术结束到首次补救镇痛或出院的时间、术中和术后应激、术后疼痛、功能恢复、慢性疼痛发生率和并发症。
所有纳入患者的种族/民族均为亚洲人（中国人）。两组的人口统计学信息相似。与术后ACB相比，术前ACB与术后24小时内显著更低的吗啡消耗量和更低的总吗啡消耗量相关。它还与首次补救镇痛的时间更长、术中阿片类药物和吸入麻醉剂的消耗量更低、手术期间高血压发作次数更少、PACU中补救镇痛率更低、术后第1天早晨血清中皮质醇和促肾上腺皮质激素水平更低、术后12小时内静息或活动时视觉模拟量表上的疼痛更低、术后第1天膝关节活动范围更好以及术后3个月慢性疼痛发生率更低相关。两组在术后行走距离、出院时间或并发症发生率方面无显著差异。
在TKA前而非后实施ACB可能导致住院期间阿片类药物消耗量更低、术中和术后应激反应更低、住院期间疼痛缓解更好以及术后3个月慢性疼痛发生率更低。
治疗水平I。有关证据水平的完整描述，请参阅作者指南。
