【罂粟摘要】超声引导膝神经阻滞作为全膝关节置换术局部浸润镇痛的替代方案：一项非劣势配对队列研究
超声引导膝神经阻滞作为全膝关节置换术局部浸润镇痛的替代方案：一项非劣势配对队列研究
全膝关节置换术的标准止痛策略为采用局部浸润方法。而膝关节神经阻滞和射频消融是治疗膝骨性关节炎慢性疼痛的有效方法。
比较膝神经阻滞与局部浸润镇痛在人工全膝关节置换术后24小时镇痛效果的非劣性。
前瞻性队列研究。
围手术期。
本前瞻性研究纳入了计划进行全膝关节置换术的35名患者，并与被纳入回顾性队列中的35名患者进行比较。
前瞻性队列中的膝状神经阻滞与回顾性队列中的局部浸润镇痛进行了比较。
疼痛数字评分和在前24小时内的累积应用阿片类药物的吗啡当量。
我们使用急性术后疼痛相关风险协变量对患者进行了倾向性评分匹配分析。经一对一倾向评分匹配后，21例纳入局部浸润镇痛组，21例纳入膝神经阻滞组。未配对队列和配对队列(满足非劣势标准，Δ=1)的24h静态数字评分的中位数差值分别为-0.99[95%可信区间(CI)，1.99~0.5，P=0.012]和-1.9(95%CI，-2~0，P=0.002)。未配对队列的累积阿片类药物用量的中位数差异为2.5 mg(95%CI，-13.5~2.5，P<0.001)，配对组为4.99 mg(95%CI，-11.5~2.5，P<0.001)(符合非劣势标准，Δ=21 mg)。
局部浸润镇痛与膝状神经阻滞镇痛效果相当。因此，膝神经阻滞可以成为全膝关节置换术患者局部浸润镇痛的替代方法。
ClinicalTrials.gov ID：NCT04024319。
翻译：佟睿 编辑：佟睿 审校：曹莹
Ultrasound-guided genicular nerves block: an analgesic alternative to local infiltration analgesia for total knee arthroplasty: A noninferiority, matched cohort study
BACKGROUND Standard analgesic strategies for total knee arthroplasty employ local infiltration analgesia. Blockade and radiofrequency ablation of the genicular nerves are effective treatments for patients with chronic pain because of knee osteoarthritis.
OBJECTIVE To test the noninferiority of the analgesic effect of genicular nerves block in comparison with local infiltration analgesia after 24h of total knee arthroplasty. DESIGN Prospective cohort study.
SETTING Perioperative setting.
PATIENTS Thirty-five patients scheduled for total knee arthroplasty were prospectively included in the study and compared with 35 patients in a retrospective cohort.
INTERVENTION Genicular nerve blocks in the prospective cohort were compared with local infiltration analgesia in the retrospective cohort.
MAIN OUTCOME MEASURES The pain numeric rating scale and the cumulative opioid consumption in oral morphine equivalents during the first 24h.
RESULTS We conducted propensity score-matched analyses of patients using acute postoperative pain-related risk covariates. After one-to-one propensity score matching, 21 patients were included in the local infiltration analgesia group and 21 in the genicular nerve block group. The median difference in numeric rating score at rest at 24h was -0.99 [95% confidence interval (CI), -1.99 to 0.5, P=0.012] on the unmatched cohort and -1.9 (95% CI, -2 to 0 , P=0.002) on the matched cohort (meeting the noninferiority criteria, Δ=1). The median difference in cumulative opioid consumption was 2.5 mg (95% CI, -13.5 to 2.5, P<0.001) for the unmatched cohort and 4.99 mg (95% CI, -11.5 to 2.5, P<0.001) on the matched group (meeting the noninferiority criteria, Δ=21 mg).
CONCLUSION Local infiltration analgesia and genicular nerve block are comparable in terms of analgesic results. Therefore, genicular nerves block is an alternative to local infiltration analgesia in patients undergoing total knee arthroplasty.
TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT04024319.