Canikli Adigüzel Şenay, Genç Caner, Kayikçi Ebru, Genç Ahmet S, Durusoy Serhat, Yildiz Adem, Tulgar Serkan
Department of Anaesthesiology and Reanimation, Samsun University Samsun Training and Research Hospital, Samsun, Turkiye.
Department of Orthopaedics and Traumatology, Samsun University Samsun Training and Research Hospital, Samsun, Turkiye.
Medicine (Baltimore). 2025 Aug 8;104(32):e43719. doi: 10.1097/MD.0000000000043719.
Total knee arthroplasty (TKA) is associated with significant postoperative pain, managed with multimodal analgesia, including regional anesthesia techniques like peripheral nerve blocks. The knee joint's innervation by both sacral and lumbar plexuses often necessitates combined blocks for effective analgesia. This study aimed to compare the effects of suprainguinal fascia iliaca block (SIFIB) and a combination of popliteal artery and posterior knee capsule injection (IPACK) with adductor canal block (ACB) on 24-hour postoperative pain scores, as well as their impact on inflammatory markers and biochemical indicators of myotoxicity. The study included patients undergoing elective unilateral primary knee arthroplasty. They were divided into 2 groups: 1 received postoperative SIFIB, and the other underwent IPACK preoperatively and ACB postoperatively. Postoperative evaluations included Numeric Rating Scale scores, morphine consumption, quadriceps muscle strength, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), systemic immune inflammation score, C-reactive protein (CRP), lactate, and creatine phosphokinase (CPK) levels as a marker of myotoxicity. CPK increases of more than 5-fold were assessed for rhabdomyolysis. Pain scores at rest and with movement were comparable between groups at all time points (P > .05). Morphine consumption over 24 hours did not differ significantly (P > .05). Similarly, inflammatory markers, including NLR, PLR, systemic immune inflammation score, CRP, and lactate, showed no significant differences between groups at 12 and 24 hours (P > .05). CPK levels, evaluated as indicators of myotoxicity and rhabdomyolysis, were also similar (P > .05). Quadriceps strength, assessed as an indicator of motor loss, showed no significant differences between groups (P > .05). The analgesic efficacy, safety, and inflammatory responses of SIFIB were comparable to those of the IPACK + ACB combination. Given its technical simplicity and ability to target multiple nerves with a single injection, SIFIB may be considered a practical alternative for postoperative analgesia in TKA. These findings may assist clinicians in selecting regional anesthesia strategies when procedural limitations exist.
全膝关节置换术（TKA）术后疼痛显著，需采用多模式镇痛管理，包括外周神经阻滞等区域麻醉技术。膝关节由骶丛和腰丛共同支配，因此常需联合阻滞以实现有效镇痛。本研究旨在比较腹股沟上髂筋膜阻滞（SIFIB）、腘动脉与后膝关节囊联合注射（IPACK）加股内侧肌管阻滞（ACB）对术后24小时疼痛评分的影响，以及它们对炎症标志物和肌毒性生化指标的影响。该研究纳入接受择期单侧初次膝关节置换术的患者。他们被分为两组：一组术后接受SIFIB，另一组术前接受IPACK且术后接受ACB。术后评估包括数字评分量表评分、吗啡用量、股四头肌力量、中性粒细胞/淋巴细胞比值（NLR）、血小板/淋巴细胞比值（PLR）、全身免疫炎症评分以及作为肌毒性标志物的C反应蛋白（CRP）、乳酸和肌酸磷酸激酶（CPK）水平。评估CPK升高超过5倍以诊断横纹肌溶解症。各时间点两组静息和活动时的疼痛评分均无显著差异（P>0.05）。24小时内吗啡用量无显著差异（P>0.05）。同样，包括NLR、PLR、全身免疫炎症评分、CRP和乳酸在内的炎症标志物在12小时和24小时时两组间无显著差异（P>0.05）。作为肌毒性和横纹肌溶解症指标评估的CPK水平也相似（P>0.05）。作为运动功能丧失指标评估的股四头肌力量在两组间无显著差异（P>0.05）。SIFIB的镇痛效果、安全性和炎症反应与IPACK+ACB联合相当。鉴于其技术操作简单且能单次注射靶向多条神经，SIFIB可被视为TKA术后镇痛的一种实用替代方法。这些研究结果可能有助于临床医生在存在操作限制时选择区域麻醉策略。
