Zhang Dan, Wang Xin, Huang GuiLi, Wu Lanying, He Yuhua, Huang Yating, Zhang Guangying
Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi Province, People's Republic of China.
Department of Anesthesiology, Liuzhou People's Hospital, Liuzhou, 545006, Guangxi Province, People's Republic of China.
Sci Rep. 2025 Mar 25;15(1):10236. doi: 10.1038/s41598-025-94343-0.
To explore the impact of ultrasound-guided proximal adductor canal and pes anserinus tendon block on early recovery after anterior cruciate ligament reconstruction surgery via daytime knee arthroscopy. A total of 127 patients, aged 18-60 years, with ASA class I-II, undergoing anterior cruciate ligament reconstruction via knee arthroscopy under general anesthesia with laryngeal mask airway intubation, were selected. These patients were randomly divided into three groups: Group C (43 cases), Group N (41 cases), and Group N (43 cases). Control group C: received proximal block of the adductor canal with 0.5% ropivacaine (15 ml); Experimental group N: received proximal block of the adductor canal combined with tendon block of the pes anserinus with 0.5% ropivacaine (15 ml per site); Experimental group N: received proximal block of the adductor canal combined with tendon block of the pes anserinus with 0.5% ropivacaine plus 5 mg dexamethasone (15 ml per site). Record the VAS scores at each time point after awakening, 3 h after surgery, 6 h after surgery, 12 h after surgery, 24 h after surgery, 48 h after surgery, and 72 h after surgery during rest and knee flexion activities of the knee joint. Record the quadriceps muscle strength after awakening, Ramsay sedation score after awakening, time of first ambulation after surgery, and the amount of sufentanil, propofol, and remifentanil used during the operation. Record the amount of tramadol and flurbiprofen axetil added postoperatively. Record the anxiety scores and rapid eye movement sleep behavior disorder scores before and 3 days after surgery. Record the occurrence of breakthrough pain and adverse reactions 3 days after surgery. Compared with Group C, both Group N and Group N showed significantly lower rest and activity VAS scores at all time points on postoperative day 3 (P < 0.05), earlier time to first ambulation after surgery (P < 0.05), significantly lower HADS-A scores and sleep scores on postoperative day 3 (P < 0.05), significantly higher Ramsay sedation scores after awakening (P < 0.05), and significantly reduced use of additional tramadol and flurbiprofen axetil after surgery (P < 0.05). The intraoperative sufentanil dosage was also significantly reduced (P < 0.05). There were no statistically significant differences in quadriceps muscle strength and adverse reactions during the awakening period among the three groups (P > 0.05). Ultrasound-guided proximal adductor canal and pes anserinus tendon block (15 ml of 0.5% ropivacaine each) can effectively alleviate pain 3 days after anterior cruciate ligament reconstruction surgery under knee arthroscopy, with good analgesic effects, and has minimal impact on quadriceps muscle strength after awakening, promoting early postoperative ambulation; at the same time, this blocking method can reduce the occurrence of postoperative anxiety and sleep disorders.
探讨超声引导下股内收肌管近端及鹅足肌腱阻滞对日间膝关节镜下前交叉韧带重建术后早期恢复的影响。选取127例年龄在18 - 60岁、ASA分级为I - II级、在喉罩气道插管全身麻醉下行膝关节镜下前交叉韧带重建术的患者。将这些患者随机分为三组：C组（43例）、N组（41例）和N组（43例）。对照组C：采用0.5%罗哌卡因（15 ml）行股内收肌管近端阻滞；实验组N：采用0.5%罗哌卡因（每部位15 ml）行股内收肌管近端阻滞联合鹅足肌腱阻滞；实验组N：采用0.5%罗哌卡因加5 mg地塞米松（每部位15 ml）行股内收肌管近端阻滞联合鹅足肌腱阻滞。记录患者苏醒后、术后3 h、6 h、12 h、24 h、48 h及72 h在膝关节休息及屈曲活动时各时间点的视觉模拟评分（VAS）。记录患者苏醒后的股四头肌肌力、苏醒后的Ramsay镇静评分、术后首次下床活动时间以及术中使用的舒芬太尼、丙泊酚和瑞芬太尼的用量。记录术后追加曲马多和氟比洛芬酯的用量。记录术前及术后3天的焦虑评分和快速眼动睡眠行为障碍评分。记录术后3天爆发性疼痛及不良反应的发生情况。与C组相比，N组和N组在术后第3天各时间点的休息及活动VAS评分均显著降低（P < 0.05），术后首次下床活动时间更早（P < 0.05），术后第3天的医院焦虑抑郁量表 - 焦虑（HADS - A）评分和睡眠评分显著降低（P < 0.05），苏醒后的Ramsay镇静评分显著升高（P < 0.05），术后追加曲马多和氟比洛芬酯的用量显著减少（P < 0.05）。术中舒芬太尼用量也显著减少（P < 0.05）。三组患者苏醒期股四头肌肌力及不良反应差异无统计学意义（P > 0.05）。超声引导下股内收肌管近端及鹅足肌腱阻滞（各15 ml 0.5%罗哌卡因）可有效缓解膝关节镜下前交叉韧带重建术后3天的疼痛，镇痛效果良好，对苏醒后股四头肌肌力影响极小，促进术后早期下床活动；同时，该阻滞方法可减少术后焦虑及睡眠障碍的发生。
