Peri-articular local infiltration analgesia versus femoral nerve block for postoperative pain control following anterior cruciate ligament reconstruction: Prospective, comparative, non-inferiority study
Peri-articular local infiltration analgesia versus femoral nerve block for postoperative pain control following anterior cruciate ligament reconstruction: Prospective, comparative, non-inferiority study
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DOI：
10.1016/j.otsr.2016.07.011
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发表时间：
2016-11-01
影响因子：
2.3
通讯作者：
Bohu, Y.
中科院分区：
文献类型：
--
作者：
Lefevre, N.;Klouche, S.;Bohu, Y.
简介：股神经阻滞（FNB）被认为是前交叉韧带（ACL）重建的主要进展，因为它减少了对胃肠外阿片类药物的需求。然而，膝关节手术后FNB引起的一过性甚至永久性神经功能缺损的发生率估计为1.94%。本研究的主要目的是比较ACL重建手术中局部浸润镇痛（LIA）与FNB。研究假设是，LIA是不低于FNB对术后早期pain.Patients和方法：前瞻性收集的数据在FAST队列的回顾性分析，包括一系列的连续患者谁接受了一个孤立的ACL的腘绳肌移植物在2013-2014年的主要修复。随着时间的推移，我们的麻醉实践发生了变化，使我们能够形成三个连续的组：组1 - FNB，组2 - FNB + LIA，组3 -仅LIA。术前进行超声引导下FNB。外科医生在手术结束时进行LIA，系统性浸润所有皮肤切口和腿筋供区;未进行关节内注射。主要终点是患者在视觉模拟量表（0-10）上描述的平均术后早期疼痛（第0-3天）。样本量计算表明，每组需要36名受试者进行非劣效性研究。结果：该研究涉及126名患者：G1 = 42，G2 = 38，G3 = 46。患者在入组时具有可比性。平均术后早期疼痛水平分别为3.1 +/- 2.4、2.8 +/- 2.0和2.5 +/- 2.2（P=0.66）。LIA组在D 0至D3时曲马多的摄入量有增加的趋势，在第1天（P=0.03）和第2天（P = 0.02）有显著的趋势检验。结论：在用腘绳肌移植物重建孤立ACL撕裂后，FNB并不比LIA更有效地减轻患者术后早期疼痛。接受FNB的患者消耗的阿片样镇痛药明显较少。(C)2016 Elsevier Masson SAS。All rights reserved.
Introduction: Femoral nerve block (FNB) is considered as a major advance in anterior cruciate ligament (ACL) reconstruction as it reduces the need for parenteral opioids. However, the incidence of transient or even permanent neurological deficits due to the FNB is estimated at 1.94% after knee surgery. The primary objective of this study was to compare local infiltration analgesia (LIA) to FNB during ACL reconstruction procedures. The study hypothesis was that LIA was not less effective than FNB on early postoperative pain.Patients and methods: A retrospective analysis of data collected prospectively in the FAST cohort included a series of continuous patients who underwent primary repair for isolated ACL with a hamstring graft in 2013-2014. Changes in our anesthesia practices over time allowed us to form three successive groups: Group 1 - FNB, Group 2 - FNB + LIA, Group 3 - LIA only. Ultrasound-guided FNB was done pre-operatively. The LIA was done at the end of the procedure by the surgeon with systematic infiltration of all skin incisions and the hamstring donor site; no intra-articular injections were performed. The primary endpoint was the average early postoperative pain (Days 0-3) described by the patient on a visual analogue scale (0-10). Sample size calculation pointed to 36 subjects being needed per group for a non-inferiority study.Results: The study involved 126 patients: G1 = 42, G2 = 38, G3 = 46. The patients were comparable at enrolment. The average early postoperative pain levels were 3.1 +/- 2.4, 2.8 +/- 2.0 and 2.5 +/- 2.2, respectively (P=0.66). A trend toward higher intake of tramadol was noted in the LIA group on DO to D3, with a significant trend test on Day 1 (P=0.03) and Day 2 (P = 0.02).Conclusion: After reconstruction of isolated ACL tears with a hamstring graft, FNB is not more effective than LIA on patients' early postoperative pain. Patients who received a FNB consumed significantly less opioid-like analgesics. (C) 2016 Elsevier Masson SAS. All rights reserved.