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本公众号每天分享一篇最新一期Anesthesia & Analgesia等SCI杂志的摘要翻译，敬请关注并提出宝贵意见 A Three-arm Randomized Clinical Trial Comparing Continuous Femoral Plus Single-injection Sciatic Peripheral Nerve Blocks versus Periarticular Injection with Ropivacaine or Liposomal Bupivacaine for Patients Undergoing Total Knee Arthroplasty 背景与目的 多模式镇痛是全膝关节置换术的标准方法; 然而，区域阻滞技术在改善围手术期结果中的作用仍然未知。研究者假设，周围神经阻滞比两种竞争性关节周围注射的方法导致更低的疼痛评分和阿片类物质的代谢 方 法 这是一项三组非盲随机试验，165名成行单侧原发性全膝关节置换术成年患者，随机分为三组（1）股骨神经置管加坐骨神经阻滞，（2）关节周围注射罗哌卡因，或（3）关节周围注射布比卡因脂质体。主要结局是在意向治疗分析中，术后第1天最大疼痛程度（0至10，数值疼痛评分量表）。次要结果包括术后2、3个月内的疼痛评分和阿片类药物的代谢。 结 果 157名患者分别给予了周围神经阻滞（n = 50），罗哌卡因（n = 55）或布比卡因脂质体（n = 52），并记录术后第1天的最大疼痛指数中位数评分为3,4和4.5， 术后当天分别为1,4和5（术后当天平均疼痛评分：0.6,1.7和2.4，术后第1天：2.5,3.5,3.7）。与关节周围注射布比卡因脂质体相比，外周神经阻滞术后第1天最大疼痛评分中位数显着降低（P = 0.016; Hodges-Lehmann中位差[95％CI] = -1 [-2至0]）。入PACU后，患者术后当天疼痛评分最大值和平均中位数与周围神经阻滞相比均显着降低（罗哌卡因：最大-2 [-3至-1]; P <0.001;平均-0.8 [ - 1.3〜-0.2]; P = 0.003;布比卡因脂质体：最大-3 [-4〜-2]; P <0.001;平均值-1.4 [-2.0〜-0.8]; P <0.001）。 结 论 关节周围注射罗哌卡因术后第1、2天的镇痛效果优于股神经置管加单次坐骨神经阻滞。本研究没有证明关节周围注射布比卡因脂质体在全膝关节置换术中的作用优于罗哌卡因。 原始文献摘要 Adam W. Amundson, M.D., Rebecca L. Johnson, M.D., Matthew P. Abdel, M.D.,el.at,A Three-arm Randomized Clinical Trial Comparing Continuous Femoral Plus Single-injection Sciatic Peripheral Nerve Blocks versus Periarticular Injection with Ropivacaine or Liposomal Bupivacaine for Patients Undergoing Total Knee Arthroplasty.Anesthesiology 2017; 126:1139-50. Background: Multimodal analgesia is standard practice for total knee arthroplasty; however, the role of regional techniques in improved perioperative outcomes remains unknown. The authors hypothesized that peripheral nerve blockade would result in lower pain scores and opioid consumption than two competing periarticular injection solutions. Methods: This three-arm, nonblinded trial randomized 165 adults undergoing unilateral primary total knee arthroplasty to receive (1) femoral catheter plus sciatic nerve blocks, (2) ropivacaine-based periarticular injection, or (3) liposomal bupivacaine-based periarticular injection. Primary outcome was maximal pain during postoperative day 1 (0 to 10, numerical pain rating scale) in intentionto- treat analysis. Additional outcomes included pain scores and opioid consumption for postoperative days 0 to 2 and 3 months. Results: One hundred fifty-seven study patients received peripheral nerve block (n = 50), ropivacaine (n = 55), or liposomal bupivacaine (n = 52) and reported median maximal pain scores on postoperative day 1 of 3, 4, and 4.5 and on postoperative day 0 of 1, 4, and 5, respectively (average pain scores for postoperative day 0: 0.6, 1.7, and 2.4 and postoperative day 1: 2.5, 3.5, and 3.7). Postoperative day 1 median maximal pain scores were significantly lower for peripheral nerve blockade compared to liposomal bupivacaine-based periarticular injection (P = 0.016; Hodges–Lehmann median difference [95% CI] = −1 [−2 to 0]). After postanesthesia care unit discharge, postoperative day 0 median maximal and average pain scores were significantly lower for peripheral nerve block compared to both periarticular injections (ropivacaine: maximal −2 [−3 to −1]; P < 0.001; average −0.8 [−1.3 to −0.2]; P = 0.003; and liposomal bupivacaine: maximal −3 [−4 to −2]; P < 0.001; average −1.4 [−2.0 to −0.8]; P < 0.001). Conclusions: Ropivacaine-based periarticular injections provide pain control comparable on postoperative days 1 and 2 to a femoral catheter and single-injection sciatic nerve block. This study did not demonstrate an advantage of liposomal bupivacaine over ropivacaine in periarticular injections for total knee arthroplasty. (Anesthesiology 2017; 126:1139-50) 麻醉学文献进展分享 联系我们 |
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