Desai Devyani, Shah Neha, Choube Kanchan
Department of Anaesthesiology, Baroda Medical College, Vadodara, Gujarat, India.
J Anaesthesiol Clin Pharmacol. 2025 Jul-Sep;41(3):470-477. doi: 10.4103/joacp.joacp_206_24. Epub 2025 Jun 2.
This study compared the dual sub-sartorial block (DSB), which allegedly includes all pain generators of the anterior and posterior compartments of the knee joint, to the routinely used single sub-sartorial bock (SSB), in terms of analgesic efficacy and preservation of motor strength after unilateral total knee arthroplasty (TKA).
Sixty patients aged 18-80 years and ASA grade I-III undergoing unilateral TKA were randomised to two groups postoperatively to receive DSB or SSB. Patients in group DSB received distal femoral triangle block (15 ml) + proximal adductor canal block (20 ml), while group SSB received only proximal adductor canal block (20 ml). Primarily, the changes in pain intensity and pain control in terms of static and dynamic visual analogue score (VAS) with the duration of analgesia and cumulative dose requirement of rescue analgesic in the first 24 hours postoperatively were studied. Secondary outcomes were the postoperative degree of motor blockade, the ability of early ambulation, patient satisfaction and complications. Statistical analysis was done using the student -test and Chi-square test using MedCalc version 12.4.3.0.
At all time intervals, the static and dynamic VAS scores were lower in the patients with the DSB group ( < 0.001) with longer duration of postoperative analgesia (14.96 ± 5.05 vs 6.03 ± 1.73 hours, < 0.0001) and less requirement of total parenteral analgesic (1.06 ± 0.37 vs 2 ± 0.52, < 0.0001) in first 24 hours postoperatively. A shorter time was required to finish the Timed Up and Go test for patients belonging to the DSB group (53.48 ± 4.06 vs 66.16 ± 6.23 seconds, < 0.0001) in comparison to group SSB.
DSB provided better pain control with a longer duration of analgesia and required fewer doses of parenteral analgesics in the first 24 hours postoperatively after TKA, as opposed to SSB. Neither block had incidences of motor weakness and other complications.
本研究比较了据称涵盖膝关节前后侧所有疼痛源的双股薄肌下阻滞（DSB）与常规使用的单股薄肌下阻滞（SSB）在单侧全膝关节置换术（TKA）后镇痛效果及运动肌力保留方面的差异。
60例年龄在18 - 80岁、ASA分级为I - III级且接受单侧TKA的患者术后随机分为两组，分别接受DSB或SSB。DSB组患者接受股远端三角阻滞（15毫升）+股收肌管近端阻滞（20毫升），而SSB组仅接受股收肌管近端阻滞（20毫升）。主要研究术后24小时内镇痛持续时间、静态和动态视觉模拟评分（VAS）方面的疼痛强度变化及补救性镇痛药的累积剂量需求。次要结局指标为术后运动阻滞程度、早期活动能力、患者满意度及并发症。使用MedCalc 12.4.3.0版本进行学生t检验和卡方检验以进行统计分析。
在所有时间点，DSB组患者的静态和动态VAS评分均较低（P < 0.001），术后镇痛持续时间更长（14.96 ± 5.05对6.03 ± 1.73小时，P < 0.0001），术后24小时内所需的全胃肠外镇痛药总量更少（1.06 ± 0.37对2 ± 0.52，P < 0.0001）。与SSB组相比，DSB组患者完成定时起立行走测试所需时间更短（53.48 ± 4.06对66.16 ± 6.23秒，P < 0.0001）。
与SSB相比，TKA术后24小时内，DSB能提供更好的疼痛控制，镇痛持续时间更长，所需胃肠外镇痛药剂量更少。两种阻滞均未出现运动无力及其他并发症。
