Background

Many regional anaesthetic techniques have been proposed to manage pain after total knee arthroplasty, but the best approach is unclear. We compared opioid consumption in the first 48 h between two different regional anaesthesia strategies in patients undergoing total knee arthroplasty.

Methods

In this single-centre, prospective study, we randomly allocated 90 patients to a combination of IPACK (interspace between popliteal artery and capsule of the posterior knee), triangle femoral and obturator nerve blocks (distal group), or a combination of sciatic, femoral, obturator, and lateral femoral cutaneous nerve blocks (proximal group). All patients received an opioid-sparing general anaesthesia regimen. The primary outcome was opioid consumption in the first 48 h. Secondary outcomes included opioid consumption in the first 24 h and verbal rating pain scores in the first 48 h.

Results

There was no difference in median cumulative oral morphine equivalent consumption at 48 h between the distal and the proximal block groups (33 [18–78] mg vs 30 [22–51] mg, respectively; P=0.29). Median oral morphine equivalent consumption at 24 h was higher in the distal group compared with the proximal group (30 [13–59] vs 15 [0–18], respectively; P<0.001). Verbal rating pain scores were lower in the proximal group compared with the distal group on arrival to the postanaesthesia care unit and at 6 and 12 h.

Conclusions

In patients undergoing total knee arthroplasty under total intravenous general anaesthesia with a multimodal analgesia regimen, proximal nerve blocks resulted in improved pain scores in the first 12 h and reduced opioid consumption in the first 24 h when compared with distal nerve blocks. No difference in pain scores or opioid consumption was seen at 48 h.

Clinical trial registration

NCT 04499716.

中文翻译：

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近端或远端联合神经阻滞用于全膝关节置换术后镇痛：一项随机对照试验

背景

已经提出了许多区域麻醉技术来控制全膝关节置换术后的疼痛，但最佳方法尚不清楚。我们比较了接受全膝关节置换术患者的两种不同区域麻醉策略在前 48 小时内的阿片类药物消耗量。

方法

在这项单中心、前瞻性研究中，我们将 90 名患者随机分配到 IPACK（腘动脉和膝后关节囊之间的间隙）、股三角和闭孔神经阻滞（远端组）或坐骨神经、股骨神经阻滞的组合、闭孔和股外侧皮神经阻滞（近端组）。所有患者均接受阿片类药物保留全身麻醉方案。主要结果是前 48 小时的阿片类药物消耗量。次要结果包括前 24 小时的阿片类药物消耗和前 48 小时的口头疼痛评分。

结果

远端和近端阻滞组在 48 小时的累积口服吗啡当量消耗量中位数没有差异（分别为 33 [18-78] mg对30 [22-51] mg；P = 0.29）。与近端组相比，远端组 24 小时口服吗啡当量的中位数较高（分别为 30 [13-59]对15 [0-18]；P <0.001）。与远端组相比，在到达麻醉后护理病房时以及在 6 小时和 12 小时时，近端组的语言评分疼痛评分较低。

结论

在采用多模式镇痛方案的全静脉全身麻醉下接受全膝关节置换术的患者中，与远端神经阻滞相比，近端神经阻滞在前 12 小时内改善了疼痛评分，并在前 24 小时内减少了阿片类药物的消耗。在 48 小时时，疼痛评分或阿片类药物消耗量没有差异。

临床试验注册

NCT 04499716。