The effect of single-injection femoral nerve block versus continuous femoral nerve block after total knee arthroplasty on hospital length of stay and long-term functional recovery within an established clinical pathway
The effect of single-injection femoral nerve block versus continuous femoral nerve block after total knee arthroplasty on hospital length of stay and long-term functional recovery within an established clinical pathway
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DOI：
10.1213/01.ane.0000198675.20279.81
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发表时间：
2006-04-01
影响因子：
5.7
通讯作者：
Mulroy, MF
中科院分区：
文献类型：
--
作者：
Salinas, FV;Liu, SS;Mulroy, MF
全膝关节置换术（TKA）可能导致严重的疼痛，单次注射股神经阻滞（SFNB）已被证明具有有限的镇痛持续时间。连续股神经阻滞（CFNB）可延长SFNB的镇痛时间。我们前瞻性地将36例接受TKA的患者随机分为CFNB和SFNB，并在标准化的临床途径中评估住院时间（LOS）的影响。次要结果包括视觉模拟评分（VAS）疼痛评分、阿片类药物消耗和12周时的长期功能恢复。术后第一天（1.7 vs 3.3 [P = 0.002]）和第二天（0.9 vs 3.2 [P < 0.0001]）， CFNB与SFNB患者的VAS静息平均评分显著低于SFNB。术后第一天（4.7 vs 6.3 [P = 0.01]）和第二天（3.9 vs 6.1 [P = 0.0005]）， CFNB与SFNB患者在物理治疗期间的平均最大VAS评分显著低于SFNB。术后第一天接受CFNB与SFNB的患者平均氧可酮消耗量显著降低：15 mg vs 40 mg (P = < 0.0001)；术后第2天20 mg vs 43 mg （P = 0.0004）。两组在医院的LOS （3.8 vs 3.9天）或长期功能恢复（12周时膝关节屈曲117度vs 113度）方面没有差异。在美国的当代医疗环境中，TKA后增加镇痛时间（CFNB）所带来的效果不足，现在可能对医院LOS和长期功能恢复的影响最小。
Total knee arthroplasty (TKA) may result in severe pain, and single-injection femoral nerve blocks (SFNB) have been demonstrated to have a limited duration of analgesia. Continuous femoral nerve blocks (CFNB) can prolong the analgesic duration of SFNB. We prospectively randomized 36 patients undergoing TKA to CFNB versus SFNB and evaluated the effect on hospital length of stay (LOS) as the primary outcome within a standardized clinical pathway. Secondary outcomes included visual analog scale (VAS) pain scores, opioid consumption, and long-term functional recovery at 12 wk. Mean VAS resting scores were significantly lower among patients who received CFNB versus SFNB: first day (1.7 vs 3.3 [P = 0.002]) and second day (0.9 vs 3.2 [P < 0.0001]) after surgery. Mean maximal VAS scores during physical therapy were significantly lower among patients who received CFNB versus SFNB: first day (4.7 vs 6.3 [P = 0.01]) and second day (3.9 vs 6.1 [P = 0.0005]) after surgery. Mean oxycodone consumption was significantly lower among patients who received CFNB versus SFNB: 15 mg versus 40 mg (P = < 0.0001) on the first day after surgery; 20 mg versus 43 mg (P = 0.0004) on the second day after surgery. There was no difference in hospital LOS (3.8 vs 3.9 days) or long-term functional recovery (117 degrees versus 113 degrees knee flexion at 12 wk) between the two groups. The lack of effect provided by increased duration of analgesia (from CFNB) after TKA may now have minimal impact on hospital LOS and long-term functional recovery in the contemporary healthcare environment within the United States.