Radiofrequency ablation of genicular nerves prior to total knee replacement has no effect on postoperative pain outcomes: a prospective randomized sham-controlled trial with 6-month follow-up
Radiofrequency ablation of genicular nerves prior to total knee replacement has no effect on postoperative pain outcomes: a prospective randomized sham-controlled trial with 6-month follow-up
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DOI：
10.1136/rapm-2018-100094
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发表时间：
2019-06-01
影响因子：
5.1
通讯作者：
Avram, Michael
中科院分区：
文献类型：
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作者：
Walega, David;McCormick, Zachary;Avram, Michael
背景和目的骨关节炎（OA）引起的顽固性慢性膝关节疼痛通常采用全膝关节置换术（TKA）治疗。TKA可能与严重的术后疼痛和持续的术后膝关节疼痛相关。术后疼痛控制不佳会对TKA后的功能结局产生负面影响，有效的阿片类药物保留镇痛是理想恢复的关键。几项试验表明膝神经射频消融术（GN-RFA）对OA引起的严重难治性膝关节疼痛患者具有临床有效性。我们的目的是评估术前GN-RFA是否会改善术后疼痛的结果后，TKA。方法这是一个假对照前瞻性临床试验中，盲参与者随机图像引导GN-RFA或模拟假手术2-6周前，选择性TKA。结果进行了评估，在48小时和1，3和6个月后TKA。结果70名参与者参加了这项研究。与假手术对照组相比，GN-RFA在任何时间点对术后阿片类药物消耗、疼痛或功能测量均无治疗效果。结论当在选择性TKA前2-6周作为多模式术后疼痛管理方案的一部分进行上级外侧、上级内侧和下内侧膝神经的冷却RFA时，对术后阿片类药物使用无可测量的影响，手术后48小时内的镇痛使用或功能。此外，我们发现TKA术后1个月、3个月和6个月对结局指标无长期影响。
Background and objectives Refractory chronic knee pain from osteoarthritis (OA) is commonly treated with total knee arthroplasty (TKA). TKA can be associated with severe postoperative pain and persistent postsurgical knee pain. Poorly controlled postoperative pain can negatively effect functional outcomes following TKA, and effective opioid-sparing analgesia is key to the ideal recovery. Genicular nerve radiofrequency ablation (GN-RFA) has been shown in several trials to be clinically effective in patients with severe refractory knee pain from OA. We aimed to assess if preoperative GN-RFA would improve postoperative pain outcomes following TKA.Methods This was a sham-control prospective clinical trial in which blinded participants were randomized to image-guided GN-RFA or a simulated sham procedure 2-6 weeks prior to elective TKA. Outcomes were assessed at 48 hours and 1, 3 and 6 months following TKA.Results Seventy participants enrolled in this study. As compared with sham controls, GN-RFA had no treatment effect on postoperative opioid consumption, pain or functional measures at any time point.Conclusions Cooled RFA of the superior lateral, superior medial and inferomedial genicular nerves, when performed 2-6 weeks prior to elective TKA as part of a multimodal postoperative pain management regime, had no measurable effect on postoperative opioid use, analgesia use or function in the 48 hours following surgery. In addition, we found no longer term effect on outcome measures 1, 3 and 6 months after TKA.