Background

Regional nerve blocks are widely used in primary total knee arthroplasty (TKA) to reduce postoperative pain and opioid consumption. The purpose of our study was to evaluate the efficacy and safety of regional nerve blocks after TKA in support of the combined clinical practice guidelines of the American Association of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, Hip Society, Knee Society, and American Society of Regional Anesthesia and Pain Management.

Methods

We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials for studies published before March 24, 2020 on femoral nerve block, adductor canal block, and infiltration between Popliteal Artery and Capsule of Knee in primary TKA. All included studies underwent qualitative and quantitative homogeneity testing followed by a systematic review and direct comparison meta-analysis to assess the efficacy and safety of the regional nerve blocks compared to a control, local peri-articular anesthetic infiltration (PAI), or between regional nerve blocks.

Results

Critical appraisal of 1,673 publications yielded 56 publications representing the best available evidence for analysis. Femoral nerve and adductor canal blocks are effective at reducing postoperative pain and opioid consumption, but femoral nerve blocks are associated with quadriceps weakness. Use of a continuous compared to single shot adductor canal block can improve postoperative analgesia. No difference was noted between an adductor canal block or PAI regarding postoperative pain and opioid consumption, but the combination of both may be more effective.

Conclusion

Single shot adductor canal block or PAI should be used to reduce postoperative pain and opioid consumption following TKA. Use of a continuous adductor canal block or a combination of single shot adductor canal block and PAI may improve postoperative analgesia in patients with concern of poor postoperative pain control.

中文翻译：

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全膝关节置换术中区域神经阻滞的疗效和安全性：系统评价和直接荟萃分析

背景

区域神经阻滞广泛用于初次全膝关节置换术 (TKA)，以减少术后疼痛和阿片类药物的消耗。我们研究的目的是评估 TKA 后区域神经阻滞的有效性和安全性，以支持美国髋膝外科医生协会、美国骨科医师学会、髋关节协会、膝关节协会和美国区域麻醉和疼痛管理学会。

方法

我们检索了 MEDLINE、Embase 和 Cochrane Central Register of Controlled Trials，以查找 2020 年 3 月 24 日之前发表的关于原发性 TKA 中股神经阻滞、内收肌管阻滞和腘动脉和膝关节囊之间浸润的研究。所有纳入的研究都经过定性和定量同质性测试，然后进行系统评价和直接比较荟萃分析，以评估区域神经阻滞与对照、局部关节周围麻醉浸润 (PAI) 或区域神经之间的有效性和安全性块。

结果

对 1,673 份出版物的批判性评估产生了 56 份代表可用于分析的最佳证据的出版物。股神经和内收肌管阻滞可有效减少术后疼痛和阿片类药物的消耗，但股神经阻滞与股四头肌无力有关。与单次内收肌管阻滞相比，使用连续的内收肌管阻滞可以改善术后镇痛。在术后疼痛和阿片类药物消耗方面，内收肌管阻滞或 PAI 之间没有差异，但两者的结合可能更有效。

结论

单次内收肌管阻滞或 PAI 应用于减少 TKA 术后疼痛和阿片类药物的消耗。对于担心术后疼痛控制不佳的患者，使用连续内收肌管阻滞或单次内收肌管阻滞与 PAI 的组合可改善术后镇痛效果。