全膝关节置换术后连续内收肌管阻滞优于单次注射：一项随机对照试验的Meta分析
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
Continuous adductor canal block is a better choice compared to single shot after primary total knee arthroplasty: A meta-analysis of randomized controlled trials
背景与目的
全膝关节置换术(TKA)后持续内收肌管阻滞(CACB)相对于单次内收肌管注射(SACB)的优势仍有争议。本研究的目的是探讨哪种ACB方法能更好地缓解TKA术后的疼痛。
方 法
对Medline、EMBASE、Cochrane控制试验中心和Web Science进行了搜索，检索过程中没有任何语言限制。只有随机临床试验（RCTs）被纳入此次meta分析中。主要结果为疼痛评分，其次为阿片类药物消耗、术后并发症和住院时间。
结 果
包括其中642位病人的8例随机临床试验（RCTs）。结果的总体证据是中等的。综合数据显示，与使用SACB相比，TKA术后使用CACB与休息或运动时的低的疼痛评分（P<0.00001）,累积吗啡用量(P=0.003)，住院时间（P=0.03）相关，而术后恶心呕吐发生率差异没有意义（P=0.55）。
结 论
与SACB相比，TKA术后使用CACB具有更好的镇痛效果。因此，建议将CACB作为TKA术后早期疼痛治疗的一种镇痛方法。
原始文献摘要
Chen Wang, Zhengjie Chen,Xinlong Ma.Continuous adductor canal block is a better choice compared to single shot after primary total knee arthroplasty: A meta-analysis of randomized controlled trials. International Journal of Surgery, 2019. 10.012. doi.org/10.1016/j.ijsu.
Background: The advantages of continuous adductor canal block (CACB) over single shot ACB (SACB) are still debatable for pain management after total knee arthroplasty (TKA). The aim of this study was to investigate which ACB method provides better pain relief after TKA.
Methods: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science were searched without any language restrictions. Only randomised clinical trials (RCTs) were included in this meta-analysis. The primary outcome was pain score, whereas the secondary outcomes included opioid consumption, post-operative complication, and length of stay.
Results: Eight RCTs with a total of 642 patients were included. The overall evidence for outcomes was moderate. The pooled data indicated that the use of CACB after TKA surgery was associated with lower pain score at rest or movement (P < 0.00001), cumulative morphine consumption (P = 0.003), and length of hospital stay (P = 0.03) compared with SACB, with no difference in nausea or vomiting rate (P = 0.55).
Conclusions: Compared with SACB, CACB provides better analgesia after TKA. Therefore, CACB is recommended as an analgesic method for early postoperative pain treatment after TKA.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：任文鑫 编辑：何幼芹 审校：王贵龙