■前交叉韧带(ACL)重建通常与中度至重度术后疼痛有关。值得注意的是,各种疼痛控制策略,股神经阻滞(FNB)与股外侧皮神经阻滞(LFCNB),带LFCNB的内收管阻滞(ACB),或关节周围鸡尾酒注射(PI),已被调查。然而,没有研究比较FNB与LFCNB的效果,带有LFCNB的ACB,和PI用于ACL重建后的疼痛控制。本研究旨在评估FNB对LFCNB的影响,带有LFCNB的ACB,和PI用于ACL重建后术后早期的疼痛缓解。
这项回顾性对照临床试验纳入了299例患者,这些患者在2016年4月至2022年10月期间在我们医院接受了ACL重建。我们根据PI的使用将这些病例分为几组(PI组),带LFCNB的FNB(FNB组),ACB和LFCNB(ACB组)用于疼痛管理。我们每个选择了40个案例,以匹配的年龄,性别,和身体质量指数(BMI),分析120例。在FNB和ACB组中,术前超声引导下注射0.75%罗哌卡因15ml。在PI组中,0.75%罗哌卡因20毫升的混合物,生理盐水20毫升,地塞米松6.6mg在手术开始时注射一半,其余在伤口闭合前注射。患者人口统计学(年龄,性别,高度,体重,和BMI)和手术数据(半月板修复的要求,手术时间,和止血带充气时间)进行分析。ACL重建后,在术后30min和4,8,12,24,48和72h记录患者的数字疼痛评分(NRS)(0-10).然后使用方差分析比较三组之间的NRS。此外,在每个小组中,使用t检验在NRS≥7组和NRS≤6组之间比较这些数据.
■患者的人口统计学和手术数据没有显着差异。术后30minPI组疼痛评分明显高于FCB组和ACB组,但在术后12、24、48和72h时降低。在FNB组中,根据NRS疼痛评分,人口统计学和手术数据无显著差异.在ACB组中,NRS≥7组的男性人数明显高于NRS≤6组(p=0.015).在PI组中,NRS≥7组止血带充气时间明显长于NRS≤6组(p=0.008)。
■使用自体腿筋重建ACL后,与神经阻滞组合相比,关节周围鸡尾酒可显着减少术后早期疼痛。
UNASSIGNED: Anterior cruciate ligament (ACL) reconstruction is commonly associated with moderate-to-severe postoperative pain. Notably, various pain control strategies, a femoral nerve block (FNB) with a lateral femoral cutaneous nerve block (LFCNB), adductor canal block (ACB) with LFCNB, or periarticular cocktail injection (PI), have been investigated. However, no studies compare the effects of FNB with LFCNB, ACB with LFCNB, and PI for pain control after ACL reconstruction. This study aimed to evaluate the impact of FNB with LFCNB, ACB with LFCNB, and PI for pain relief in the early postoperative period after ACL reconstruction.
UNASSIGNED: This retrospective controlled clinical trial enrolled 299 patients who underwent primary ACL reconstruction at our hospital between April 2016 and October 2022. We categorized these cases into groups based on the use of PI (PI group), FNB with LFCNB (FNB group), and ACB with LFCNB (ACB group) for pain management. We selected 40 cases each, with matched age, sex, and body mass index (BMI) from each group, resulting in 120 cases for analysis. In the FNB and ACB groups, 0.75% ropivacaine 15 ml was injected under ultrasound guidance preoperatively. In the PI group, a mixture of 0.75% ropivacaine 20 ml, normal saline 20 ml, and dexamethasone 6.6 mg was injected half at the start of surgery and the rest just before wound closure. Patient demographics (age, sex, height, body weight, and BMI) and surgical data (the requirement for meniscal repair, operative time, and tourniquet inflation time) were analyzed. After ACL reconstruction, patients\' numerical rating scale pain scores (NRS) (0-10) were recorded at 30 min and 4, 8, 12, 24, 48, and 72 h postoperatively. NRS were then compared among the three groups using analysis of variance. In addition, within each group, these data were compared between the NRS ≥7 and NRS ≤6 groups using a t-test.
UNASSIGNED: There were no significant differences in patient demographics and surgical data. Pain scores were significantly higher in the PI group than in the FCB and ACB groups 30 min postoperatively, but they were lower at 12, 24, 48, and 72 h postoperatively. In the FNB group, there were no significant differences in the demographic and surgical data by NRS pain score. In the ACB group, the number of men was significantly higher in the NRS ≥7 group than in the NRS ≤6 group (p = 0.015). In the PI group, tourniquet inflation time was significantly longer in the NRS ≥7 group than in the NRS ≤6 group (p = 0.008).
UNASSIGNED: Following ACL reconstruction using a hamstring autograft, periarticular cocktail significantly reduced early postoperative pain compared with nerve block combinations.