UNASSIGNED: To compare the early analgesic effects and the impact on knee joint function recovery after unicompartmental knee arthroplasty (UKA) between single adductor canal block (SACB) and continuous adductor canal block (CACB) combined with local infiltration anesthesia (LIA) using a prospective study.
UNASSIGNED: The patients with knee osteoarthritis admitted between April 2022 and December 2023 were enrolled as a subject. Among them, 60 patients met the selection criteria and were enrolled in the study. They were randomly assigned to the SACB group or CACB group in a ratio of 1:1 using a random number table method. There was no significant difference between the two groups ( P>0.05) in terms of age, gender, height, body mass, body mass index, affected side, and preoperative resting visual analogue scale (VAS) score and active VAS score, Oxford knee score (OKS), and American Hospital of Special Surgery (HSS) score. All patients received multimodal analgesia management using LIA combined with SACB or CACB. The operation time, pain related indicators (resting and activity VAS scores, number and timing of breakthrough pain, opioid consumption), joint function related indicators (quadriceps muscle strength, knee range of motion, OKS score, and HSS score), as well as postoperative block complications and adverse events were recorded and compared between the two groups.
UNASSIGNED: There was no significant difference in the operation time between the two groups ( P<0.05). All patients in the two groups were followed up with a follow-up time of (9.70±4.93) months in the SACB group and (12.23±5.05) months in the CACB group, and the difference was not significant ( P>0.05). The CACB group had a significant lower resting VAS score at 24 hours after operation compared to the SACB group ( P<0.05). There was no significant difference in resting and active VAS scores between the two groups at other time points ( P>0.05). The CACB group had a significantly lower incidence of breakthrough pain compared to the SACB group [9 cases (30.00%) vs. 17 cases (56.67%); P<0.05). However, there was no significant difference in the timing of breakthrough pain occurrence and opioid consumption between the two groups ( P>0.05). Four cases in the SACB group and 7 cases in the CACB group experienced adverse events, with no significant difference in the incidence of adverse events between the two groups ( P>0.05). The CACB group had significantly better knee joint mobility than the SACB group at 1 and 2 days after operation ( P<0.05). There was no significant difference between the two groups in knee joint mobility on 0 day after operation and quadriceps muscle strength and OKS and HSS scores at different time points ( P>0.05).
UNASSIGNED: In UKA, the analgesic effects and knee joint function recovery are similar when compared between LIA combined with SACB and LIA combined with CACB. However, SACB is simpler to perform and can avoid adverse events such as catheter displacement and dislocation. Therefore, SACB may be a better choice.
UNASSIGNED: 采用前瞻性对比研究，比较分析膝关节单髁置换术（unicompartmental knee arthroplasty，UKA）术中采用局部浸润麻醉（local infiltration anesthesia，LIA）联合单次收肌管阻滞（single adductor canal block，SACB）或连续收肌管阻滞（continuous adductor canal block，CACB）的早期镇痛效果及对膝关节功能恢复的影响。.
UNASSIGNED: 以2022年4月—2023年12月收治的膝关节骨关节炎患者作为研究对象，其中60例符合选择标准纳入研究，按照随机数字表法以1∶1比例分配至SACB组或CACB组。两组患者年龄、性别、身高、体质量、身体质量指数、手术侧别以及术前静息疼痛视觉模拟评分（VAS）、活动VAS评分、牛津大学膝关节评分（OKS）和美国特种外科医院（HSS）评分等基线资料比较，差异均无统计学意义（ P>0.05）。两组患者接受LIA联合SACB或CACB多模式镇痛管理。记录并比较两组手术时间、疼痛相关指标（静息以及活动VAS评分，发生突破性疼痛例数及时间，阿片类药物消耗量）、关节功能相关指标（股四头肌肌力、膝关节活动度、OKS评分和HSS评分）以及术后阻滞并发症、不良事件。.
UNASSIGNED: 两组手术时间差异无统计学意义（ P<0.05）。两组患者术后均获随访，SACB组随访时间为（9.70±4.93）个月、CACB组为（12.23±5.05）个月，差异无统计学意义（ P>0.05）。除CACB组术后24 h静息VAS评分低于SACB组，差异有统计学意义（ P<0.05）外，其余各时间点两组静息和活动VAS评分比较差异均无统计学意义（ P>0.05）。 CACB组9例（30.00%）发生突破性疼痛，较SACB组17例（56.67%）减少，发生率差异有统计学意义（ P<0.05）；但两组突破性疼痛发生时间和阿片类药物消耗量比较，差异均无统计学意义（ P>0.05）。SACB组4例、CACB组7例发生不良事件，发生率差异无统计学意义（ P>0.05）。CACB组术后1、2 d膝关节活动度优于SACB组（ P<0.05）；两组术后0 d膝关节活动度以及各时间点股四头肌肌力、OKS评分、HSS评分比较，差异均无统计学意义（ P>0.05）。.
UNASSIGNED: UKA术中LIA联合SACB或CACB镇痛效果以及患者膝关节功能恢复程度相似，但SACB具有操作简便，能避免导管移位、脱位等不良事件发生，可能是一种更好选择。.

BACKGROUND: The adductor canal block is a well-known procedure for controlling postoperative pain after medial malleolus fracture surgery. Continuous nerve block is a viable option for blocking pain for a longer period although the literature on this subject is scarce. Therefore, this study aimed to compare continuous adductor canal block (cACB) group to single-injection adductor canal block (sACB) group in those with bimalleolar or trimalleolar ankle fractures. The procedure was performed in addition to a continuous sciatic nerve block for postoperative pain relief and patient satisfaction.
METHODS: The study included 57 patients who had bimalleolar or trimalleolar ankle fractures and underwent open reduction and internal fixation between August 2016 and June 2018. Each patient received a continuous sciatic nerve block and was divided into two groups: those who received cACB and those who received sACB. Each postoperative pain was scored at 4, 8, 12, 24, 48, and 72 h after surgery. Additionally, the consumption of rescue medications and patient satisfaction were evaluated.
RESULTS: The two groups displayed no disparity in medial side ankle pain at 4 h and 8 h after surgery, but significantly higher pain in the sACB group at 12, 24, 48, and 72 h after surgery. However, there was no difference in the pain at the lateral side of ankle and consumption of rescue medication. In addition, the cACB group showed more satisfaction than the sACB group did.
CONCLUSIONS: CACB is better than sACB in terms of postoperative pain control and patient satisfaction. cACB can be used for postoperative pain control in ankle fractures involving the medial malleolus.
METHODS: Prospective Randomized Controlled Trial, Level 2.

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.

UNASSIGNED: Glucocorticoids are commonly utilised as adjuvants to enhance nerve block quality and prolong the analgesic duration. Its systemic effects, after a single-injection adductor canal block (ACB) followed by a continuous infusion, are unclear. The aim of the study was to assess the systemic effects of a single dose of dexamethasone sodium phosphate (DEX), or a combination of DEX and methylprednisolone acetate (MPA), on fasting blood glucose (FBG) and white blood cell count (WBC) when administered perineurally via ACB.
UNASSIGNED: A single-center retrospective study on total knee arthroplasty (TKA) was performed and a total of 95 patients were included in the final analysis. Patients were divided into three groups based on adjuvants received in ACB: Control group (N = 41) and two treatment groups, DEX group (N = 33) and DEX/MPA group (N = 21). Our primary outcomes were the change of FBG from its preoperative baseline value on postoperative day (POD) 2. The secondary outcomes included change of FBG on POD 0 and POD 1, and change of WBC on POD 0, POD 1, and POD 2.
UNASSIGNED: The FBG change from baseline in the DEX group was significantly higher than that in the control group (difference = 14.04, 95% CI: 1.3 to 26.77), P = 0.031) on POD 0. The WBC change from baseline in the DEX/MPA group was statistically significant higher than control on POD 0 (2.62 (1.52 to 3.37), P < 0.0001). No significant differences between DEX and DEX/MPA group were found on any given postoperative days for FBG and WBC.
UNASSIGNED: This study provided preliminary safety data on the use of a combination of glucocorticoids with hydrophilic (DEX) and lipophilic (MPA) properties as local anesthetic adjuvants in ACB, which induced similar levels of changes on FBG and WBC as those from both control and DEX alone group.

UNASSIGNED: Ultrasound-guided continuous adductor canal block (cACB) is a conventional choice in patients undergoing total knee arthroplasty (TKA) for the management of the postoperative pain. This study aims to compare different catheter tip locations for cACB relative to the saphenous nerve (anteriorly vs posteriorly) in terms of efficacy and complications.
UNASSIGNED: At the department of Surgical Sciences, Orthopedic Trauma and Emergencies of the University of Naples Federico II (Naples, Italy), between January 2020 and November 2021, retrospective comparative study was executed. Patients planned for TKA were included in the study if they met the follow inclusion criteria: patients undergone TKA; aged 50-85 years; body mass index (BMI) of 18-35 kg/m2; American Society of Anesthesiologists (ASA) physical status classification from I to III; subarachnoid technique for anesthesiology plane; continuous adductor canal block performed by an anesthetist with considerable experience. Patients were assigned to receive cACB with the catheter tip located anteriorly (Group 1, G1) or posteriorly to the saphenous nerve (Group 2, G2). Postoperative pain, ambulation ability, episodes of pump block and rate of catheter dislodgement and leakage were evaluated and analyzed.
UNASSIGNED: Altogether, 102 patients were admitted to the study (48 in G1 and 54 in G2). After the first 8 postoperative hours, in G1 17 patients (35.4%) had a VAS greater than 4, while in group 2 only 3 patients (5.6%) had a VAS greater than 4 (p-value <0.01). All patients of both groups showed ambulation ability in the postoperative period. No episode of leakage was recorded. While the catheter displacement rate was similar in the two groups (2.1% for G1 vs 3.7% for G2; p-value >0.05), the episodes of pump block were significantly less in G2 than in G1 (3.7% vs 20.8%; p-value <0.01).
UNASSIGNED: In cACB for TKA, we found that positioning the catheter tip posteriorly to the saphenous nerve may lead to a greater postoperative analgesia and reduce the risk of pump block compared to placing the catheter tip anteriorly to the nerve.

An ultrasound-guided anesthetic technique targeting the interspace between the popliteal artery and capsule of the posterior knee (iPACK) can provide posterior knee analgesia with preserved motor function after total knee arthroplasty (TKA). This study compared the peroneal nerve motor-sparing effects of iPACK block and tibial nerve block (TNB) when combined with local infiltration analgesia (LIA) and continuous adductor canal block (CACB).
In this study, 105 patients scheduled for elective TKA were randomized to receive proximal iPACK block (iPACK1), distal iPACK block (iPACK2), or TNB, along with spinal anesthesia, modified LIA, and CACB. The primary outcome was the incidence of common peroneal nerve (CPN) motor blockade. Secondary outcomes included CPN sensory function, tibial sensorimotor function, posterior knee pain, pain score, intravenous morphine requirement, timed up-and-go test, quadriceps muscle strength, range of motion, length of hospital stay, patient satisfaction, and adverse events.
The incidence of CPN motor blockade was significantly higher in the TNB group than in the iPACK1 (p=0.001) and iPACK2 (p=0.001) groups, but was not significant between the iPACK1 and iPACK2 groups (p=0.76). Tibial nerve motor function was more preserved in the iPACK1 and iPACK2 groups than in the TNB group (p<0.001 and p<0.001, respectively). Complete CPN and tibial sensorimotor blockade were not observed in the iPACK2 group. Posterior knee pain score was significantly higher in the iPACK1 group than in other groups during the 24-hour postoperative period (p=0.001).
Compared with TNB, iPACK1 and iPACK2 preserved CPN and tibial nerve motor function to a greater extent. However, iPACK2 did not demonstrate complete CPN and tibial nerve motor blockade while maintaining effective posterior knee pain relief.
TCTR20180206002.

暂无摘要。

BACKGROUND: The advantages of continuous adductor canal block (CACB) over single shot ACB (SACB) are still debatable for pain management after total knee arthroplasty (TKA). The aim of this study was to investigate which ACB method provides better pain relief after TKA.
METHODS: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science were searched without any language restrictions. Only randomised clinical trials (RCTs) were included in this meta-analysis. The primary outcome was pain score, whereas the secondary outcomes included opioid consumption, post-operative complication, and length of stay.
RESULTS: Eight RCTs with a total of 642 patients were included. The overall evidence for outcomes was moderate. The pooled data indicated that the use of CACB after TKA surgery was associated with lower pain score at rest or movement (P < 0.00001), cumulative morphine consumption (P = 0.003), and length of hospital stay (P = 0.03) compared with SACB, with no difference in nausea or vomiting rate (P = 0.55).
CONCLUSIONS: Compared with SACB, CACB provides better analgesia after TKA. Therefore, CACB is recommended as an analgesic method for early postoperative pain treatment after TKA.

BACKGROUND: Novel methods of postoperative analgesia for total knee arthroplasty (TKA) have demonstrated improved functional outcomes and decreased narcotic consumption. These approaches include continuous adductor canal blocks (CACB) and periarticular injection (PAI). There is a lack of current understanding regarding the effect of these modalities on narcotic usage, functionality, and pain when both PAI and CACB are utilized compared to PAI alone.
METHODS: TKAs were performed unilaterally by a single surgeon with a standardized protocol. Patients were divided into two groups: those receiving PAI alone (n = 54) and those receiving PAI and CACB (n = 37). Patient outcomes including, narcotics usage, pain scale, and distance walked, were recorded on postoperative day (POD) zero through three.
RESULTS: When compared with PAI alone, it was identified that concurrent use of PAI and CACB results in a statistically significant decrease in narcotics usage on POD 0, 1, 3, and total narcotic usage while admitted. Patients in the PAI and CACB group walked significantly farther than patients in the PAI only group on POD 1, 2, and 3. On POD 0, patients in the PAI and CACB reported significantly less pain with activity when compared to the PAI only group.
CONCLUSIONS: Here we identify an additive effect when utilizing both PAI and CACB for postoperative TKA analgesia. Our findings demonstrate significant decrease in patient total narcotic usage, pain scores, and an increase in walking distance when utilizing PAI and CACB compared with PAI alone. This analgesic technique may help reduce patients\' narcotic use while also increasing functional outcomes.

Peripheral nerve block and local infiltration analgesia (LIA) have an increasing role as part of multimodal analgesia for enhanced recovery after total knee arthroplasty (TKA). We hypothesized that the combination of obturator nerve block (ONB) and tibial nerve block (TNB) would reduce pain and opioid consumption more than ONB or TNB alone when combined with continuous adductor canal block and LIA.
Ninety patients were recruited into the study and received spinal anesthesia, LIA, and continuous adductor canal block. They were further randomized to receive either an ONB (group 1), a TNB (group 2), or both (group 3). The primary outcome was total morphine consumption over the postoperative 24 hours. The secondary outcomes included visual analog scale scores, time to first and total dosage of rescue analgesia, Timed Up and Go test, range of motion, muscle strength test, hospital stay, and patient satisfaction.
Eighty-nine patients completed analysis. The median total morphine consumption during the first 24 postoperative hours was 2 mg (interquartile range [IQR] 0-4) in group 3, 4 mg (IQR 2-8) in group 2, and 6 mg (IQR 6-14) in group 1 (P < .001). Posterior knee pain during the first 24 hours postoperatively was significantly lower in group 3 than in group 1 (P = .006). The ability to ambulate and quadriceps strength were significantly better in group 3 than in the other groups.
The combination of triple nerve block was superior to double nerve block in improving analgesia and functional outcomes in the immediate postoperative period after total knee arthroplasty, when combined with LIA.