Abstract：
BACKGROUND: Our aim was to study the additive effect of surgeon-administered adductor canal infiltration (SACI) over routine periarticular infiltration (PAI) on pain control [morphine consumption and pain score by the visual analog scale (VAS)] and early function [flexion and Timed Up and Go (TUG) test] post-total knee arthroplasty (TKA).
METHODS: We prospectively randomized 60 patients into 2 groups. Group I patients received the standard PAI, whereas in Group II, the patients received a SACI in addition to the PAI. The total volume of the injected drug and the postoperative pain management protocol were the same for all. The number of doses of patient-controlled analgesia (PCA) used for breakthrough pain was recorded as PCA consumption. For early function, flexion and the TUG test were used. The VAS score and PCA consumption were compared between the 2 groups by using analyses of variance with post hoc tests as indicated. The TUG test and flexion were compared using Student t tests. The level of significance was set at 0.05.
RESULTS: The PCA consumption in the first 6 hours was significantly higher in Group I (P = .04). The VAS at 6 hours was significantly lower in Group II (P = .042). The TUG test was comparable between the 2 groups preoperatively (P = .72) at 24 hours (P = .60) and 48 hours (P = .60) post-TKA. The flexion was comparable between the 2 groups preoperatively (P = .85) at 24 hours (P = .48) and 48 hours (P = .79) post-TKA.
CONCLUSIONS: Adding a SACI to PAI provides improved pain relief and reduces opioid consumption without affecting early function post-TKA. A SACI avoids the need for an anesthesiologist or specialized equipment with no added operating time and minimal added cost. We recommend routine use of SACI for all patients undergoing TKA.
METHODS: We prospectively randomized 60 patients into 2 groups. Group I patients received the standard PAI, whereas in Group II, the patients received a SACI in addition to the PAI. The total volume of the injected drug and the postoperative pain management protocol were the same for all. The number of doses of patient-controlled analgesia (PCA) used for breakthrough pain was recorded as PCA consumption. For early function, flexion and the TUG test were used. The VAS score and PCA consumption were compared between the 2 groups by using analyses of variance with post hoc tests as indicated. The TUG test and flexion were compared using Student t tests. The level of significance was set at 0.05.
RESULTS: The PCA consumption in the first 6 hours was significantly higher in Group I (P = .04). The VAS at 6 hours was significantly lower in Group II (P = .042). The TUG test was comparable between the 2 groups preoperatively (P = .72) at 24 hours (P = .60) and 48 hours (P = .60) post-TKA. The flexion was comparable between the 2 groups preoperatively (P = .85) at 24 hours (P = .48) and 48 hours (P = .79) post-TKA.
CONCLUSIONS: Adding a SACI to PAI provides improved pain relief and reduces opioid consumption without affecting early function post-TKA. A SACI avoids the need for an anesthesiologist or specialized equipment with no added operating time and minimal added cost. We recommend routine use of SACI for all patients undergoing TKA.
摘要：
背景：我们的目的是研究外科医生给予内收肌管浸润（SACI）相对于常规关节周围浸润PAI对全膝关节置换术（TKA）后疼痛控制[通过视觉模拟评分（VAS）进行的吗啡消耗和疼痛评分]和早期功能[屈曲和定时向上（TUG）测试]的累加作用。
方法：我们将60例患者随机分为两组。第一组患者接受标准PAI，而在第二组中，患者除接受PAI外还接受了SACI。注射药物的总体积和术后疼痛管理方案均相同。用于突破性疼痛的患者自控镇痛（PCA）的剂量数记录为PCA消耗量。对于早期功能，使用屈曲和TUG试验。通过使用方差分析和事后检验比较两组之间的VAS评分和PCA消耗。使用Studentt检验比较TUG检验和屈曲。显著性水平设定为0.05。
结果：前6小时的PCA消耗量在I组中明显更高（P=0.04）。第6小时的VAS在II组中显著较低(P=0.042)。两组术前的TUG检验具有可比性（P=0.72），在24小时（P=0.60），TKA术后48小时（P=0.60）。术前两组患者的屈曲度具有可比性(P=0.85),在24小时（P=0.48），和TKA后48小时（P=0.79）。
结论：在PAI中添加SACI可以改善疼痛缓解，减少阿片类药物的消耗，而不影响TKA后的早期功能。SACI避免了对麻醉师或专门设备的需要,而没有增加的操作时间和最小的增加的成本。我们建议所有接受TKA的患者常规使用SACI。
方法：我们将60例患者随机分为两组。第一组患者接受标准PAI，而在第二组中，患者除接受PAI外还接受了SACI。注射药物的总体积和术后疼痛管理方案均相同。用于突破性疼痛的患者自控镇痛（PCA）的剂量数记录为PCA消耗量。对于早期功能，使用屈曲和TUG试验。通过使用方差分析和事后检验比较两组之间的VAS评分和PCA消耗。使用Studentt检验比较TUG检验和屈曲。显著性水平设定为0.05。
结果：前6小时的PCA消耗量在I组中明显更高（P=0.04）。第6小时的VAS在II组中显著较低(P=0.042)。两组术前的TUG检验具有可比性（P=0.72），在24小时（P=0.60），TKA术后48小时（P=0.60）。术前两组患者的屈曲度具有可比性(P=0.85),在24小时（P=0.48），和TKA后48小时（P=0.79）。
结论：在PAI中添加SACI可以改善疼痛缓解，减少阿片类药物的消耗，而不影响TKA后的早期功能。SACI避免了对麻醉师或专门设备的需要,而没有增加的操作时间和最小的增加的成本。我们建议所有接受TKA的患者常规使用SACI。
