内收肌管阻滞与局部浸润镇痛在前交叉韧带重建术后疼痛中的比较：单中心随机对照三盲试验
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Adductor canal block versus local infifiltration analgesia for postoperative pain after anterior cruciate ligament reconstruction: a single centre randomised controlled triple-blinded trial
背景与目的
内收肌管阻滞 (ACB) 和局部浸润镇痛(LIA) 均是前交叉韧带重建（ACL）术后有效的镇痛方法，但迄今为止都未对这两种方法进行比较。本次随机对照三盲试验旨在验证ACL术后ACB镇痛效果优于LIA这一假设，并进一步关注术后功能恢复。
方 法
将104例于全身麻醉下行前交叉韧带重建的患者，随机分配到超声引导下内收肌管阻滞组或局部浸润镇痛组，每组52人。对每组患者注射0.5%罗哌卡因20ml。术后疼痛处理采用预先设定的患者自控静脉注射吗啡、扑热息痛和布洛芬的方案。术后24h内静脉注射吗啡的累计使用量作为主要结果。与疼痛相关的次要结果包括术后2h、24h、48h的静息和动态疼痛评分（满分为10分），以及术后2h、48h静脉注射吗啡的累计使用量。早期功能相关结果评估为术后24h、48h的股四头肌肌力、步行距离和活动范围。晚期功能相关结果评估为术后4个月和8个月同轴股四头肌肌力、单跳试验、三跳试验、交叉试验和Y平衡试验。
结 果
两组患者24h内静脉注射吗啡的累计使用量相似（ACB组：17.1mg[95%CI：13.1-21.2]；LIA组：17.7mg[95%CI:13.2-22.6]，P=0.84）。同样地，两组间在继发性疼痛或功能相关结果上并无差异。
结 论
前交叉韧带重建术后，内收肌管阻滞和局部浸润镇痛两者的阿片类药物使用量相当，对术后疼痛评分和功能结果的影响相似。
原始文献摘要
Kevin Stebler, Robin Martin, Kyle R. Kirkham, et al. Adductor canal block versus local infifiltration analgesia for postoperative pain after anterior cruciate ligament reconstruction: a single centre randomised controlled triple-blinded trial [J]. Br J Anaesth 2019 May 23. DOI：10.1016/j.bja. 2019. 04.053 .
Background: Both the adductor canal block (ACB) and local infifiltration analgesia (LIA) are effective analgesic techniques after anterior cruciate ligament (ACL)reconstruction, but they have never been compared head-to-head. This rando mised controlled triple-blinded trial tested the hypothesis that ACB provides superior analgesia to LIA after ACL reconstruction, with additional focus on postoperative functional outcomes.
Methods: Of 104 enrolled ACL reconstruction patients receiving general anaesthesia, 52 were randomly allocated to either ACB under ultrasound guidance or LIA. For each intervention, ropivacaine 0.5%, 20 ml was injected. Postoperative
pain treatment followed a predefifined protocol with i.v. patient-controlled morphine, paracetamol, and ibuprofen. The primary outcome was cumulative i.v. morphine consumption at 24 h after operation. Secondary pain-related outcomes included resting and dynamic pain scores (numeric rating scale out of 10) measured 2, 24, and 48 h after operation and cumulative i.v. morphine consumption 2 and 48 h after operation. Early function-related outcomes evaluated were quadriceps strength, walking distance, and range of motion, all measured 24 and 48 h after operation. Late function-related outcomes were concentric quadriceps strength, single-hop test, triple-hop test, cross-over test, and Y balance test, measured at 4 and 8 postoperative months.
Results: Cumulative i.v. morphine consumption at 24 h was similar between groups (ACB group: 17.1 mg [95% confifidence interval, CI: 13.1, 21.2]; LIA group: 17.7 mg [95% CI: 13.2, 22.6], P=0.84). Similarly, no differences between groups were seen in the secondary pain- or function-related outcomes.
Conclusions: ACB and LIA result in equivalent postoperative opioid consumption with similar impact on postoperative pain scores and functional outcomes.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：牛振英 编辑：何幼芹 审校：王贵龙