PDF(Pubmed)
Abstract：
Introduction Total knee arthroplasty (TKA) is associated with severe acute postoperative pain. The use of tourniquets and drains (T/D) is common in TKA but may have an influence on postoperative pain and muscular strength. The infiltration of local anesthetic between the popliteal artery and capsule of the knee (iPACK block) is a motor-sparing block that provides analgesia to the posterior aspect of the knee. However, evidence regarding its efficacy is scarce. This study aims to assess the effectiveness of iPACK block and the impact of T/D use on pain and muscular strength after TKA. Material and methods A retrospective study was carried out including patients who underwent TKA from January 2020 to April 2023. Patients were allocated into groups according to the peripheral nerve block performed and T/D use. Results We included 415 patients in this study. No differences were found in pain at rest or the need for rescue analgesia between patients who received an iPACK block or sciatic nerve block (SNB) with T/D applied. Patients who received a SNB reported lower pain scores on movement (p = 0.019), but with a higher prevalence of motor block (p < 0.001). Patients who underwent surgery without using T/D reported lower pain scores on movement (p = 0.021) and reduced need for rescue analgesia (p = 0.041). Conclusion These findings indicate that iPACK block can facilitate early mobilization after TKA without significant impact on postoperative muscle strength. Furthermore, the use of a T/D may be a source of postoperative pain that could compromise early rehabilitation.
摘要：
介绍全膝关节置换术（TKA）与严重的急性术后疼痛有关。止血带和引流管（T/D）在TKA中很常见，但可能会影响术后疼痛和肌肉力量。局部麻醉剂在pop动脉和膝关节囊之间的浸润（iPACK阻滞）是一种保留运动的阻滞，可为膝关节的后部提供镇痛作用。然而,关于其功效的证据很少。这项研究旨在评估iPACK阻滞的有效性以及T/D使用对TKA后疼痛和肌肉力量的影响。材料和方法进行了一项回顾性研究，包括2020年1月至2023年4月接受TKA的患者。根据进行的周围神经阻滞和T/D使用情况将患者分组。结果本研究纳入415例患者。在接受iPACK阻滞或坐骨神经阻滞（SNB）并施加T/D的患者之间，在静息疼痛或需要抢救镇痛方面未发现差异。接受SNB的患者在运动时报告疼痛评分较低（p=0.019），但运动阻滞的患病率较高(p<0.001)。未使用T/D接受手术的患者报告了较低的运动疼痛评分（p=0.021）和减少的抢救镇痛需求（p=0.041）。结论iPACK阻滞可促进TKA术后早期活动,对术后肌力无明显影响。此外，T/D的使用可能是影响早期康复的术后疼痛的一个来源.
