股神经阻滞(FNB)是减轻前交叉韧带重建术(ACLR)患者术后疼痛的常用技术,但它也与许多不利影响有关，比如股四头肌无力,止痛剂行走，跌倒风险增加。肌管阻滞（ACB）已被提供作为FNB的运动神经保护替代品。
评估现有文献，比较ACB和FNB对关节镜ACLR术后功能结局的影响。
系统评价。
遵循2009年PRISMA（系统审查和荟萃分析的首选报告项目）指南，搜索PubMed(Ovid)，CINAHL,Scopus,科克伦,和谷歌学者数据库进行。搜索词旨在捕获比较ACB和FNB在接受关节镜ACLR的患者中的效果的研究。评估了有关研究和患者特征的数据，功能措施，阿片类药物的消费，疼痛评分,和并发症。
纳入8项随机对照试验（N=655例患者），比较ACB与FNB在关节镜ACLR中的疗效。结果测量的异质性排除了荟萃分析。七项研究报告了功能措施，包括等速力量，直腿抬高,和其他各种措施。随访时间在1小时至6个月之间变化。在3次试验中,在手术后的前12至24小时内，发现ACB可以保持股四头肌力量，使用直腿抬高进行测量。而其他3项试验发现组间没有差异。在6个月时，等速运动强度没有差异。在其他功能措施中，ACB优于FNB或等同于FNB。大多数报告阿片类药物消费的研究，疼痛评分,和并发症没有发现块之间的差异。
本系统综述表明，与FNB相比，ACB在ACLR术后早期保留股四头肌功能，同时提供相似的镇痛水平。这项研究的局限性包括使用各种功能措施和有限的长期随访。需要更多的研究用标准化措施评估长期功能结果，以得出关于ACB和FNB对ACLR后功能影响的充分结论。
Femoral nerve block (FNB) is a popular technique for reducing postoperative pain in patients with anterior cruciate ligament reconstruction (ACLR), but it is also linked to a number of adverse effects, such as quadriceps weakness, antalgic ambulation, and increased fall risk. Adductor canal block (ACB) has been offered as a motor nerve-sparing alternative to FNB.
To evaluate available literature that compares the effects of ACB and FNB on functional outcomes after arthroscopic ACLR.
Systematic
review.
Following the 2009 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a search of PubMed (Ovid), CINAHL, Scopus, Cochrane, and Google Scholar databases was conducted. Search terms were designed to capture studies comparing the effects of ACB and FNB in patients undergoing arthroscopic ACLR. Data were evaluated regarding study and patient characteristics, functional measures, opioid consumption, pain scores, and complications.
Eight randomized controlled trials (N = 655 patients) comparing the efficacy of ACB versus FNB in arthroscopic ACLR were included. The heterogeneity of outcome measures precluded meta-analysis. Seven studies reported functional measures, which included isokinetic strength, straight-leg raise, and other various measures. Follow-up periods varied between 1 hour and 6 months. In 3 trials, ACB was found to preserve quadriceps strength as measured using straight-leg raise for the first 12 to 24 hours after surgery, while 3 other trials found no difference between the groups. No differences were reported in isokinetic strength at 6 months. In other functional measures, ACB either outperformed or was equivalent to FNB. The majority of studies reporting opioid consumption, pain scores, and complications found no differences between the blocks.
This systematic
review suggests that when compared with FNB, ACB preserves quadriceps function in the early postoperative period after ACLR while providing a similar level of analgesia. Limitations of this study include the use of various functional measures and limited long-term follow-up. More research evaluating long-term functional outcomes with standardized measures is needed to draw adequate conclusions regarding the effects of ACB and FNB on function after ACLR.
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