■为了研究单注射内收肌管阻滞(ACB)和膝关节动脉和关节囊之间的穿刺术(IPACK)是否与单独的ACB相比,对接受单侧全膝关节置换术(TKA)的患者提供更好的术后疼痛管理。
■这项回顾性队列研究包括成年患者,单侧TKA。患者分为2组:单发ACB(布比卡因0.25%)和单发ACB+IPACK(布比卡因0.25%,右美托咪定1mg/kg,和地塞米松4毫克)。患者倾向匹配为1:1。主要研究结果是每8小时间隔和术后一天将阿片类药物的总消耗量转化为吗啡毫克当量(MME)。次要结果包括疼痛评分,逗留时间,步行距离,回到急诊室,医院再入院,和30天的不良事件。
■确认了180名患者,其中倾向匹配使用71%产生64例单独接受ACB和64例联合接受ACB+IPACK的患者。在整个术后住院期间,ACB+IPACK组合的总总结性MME显着降低(P=.002),并在最初24小时后累积(P<.001)。ACB+IPACK组合术后0-8小时(P=0.005)和8-16小时(P=0.009)的平均疼痛评分也较低。次要结果没有显着差异。
■联合单次ACB+IPACK阻滞与早期术后大部分时间较低的麻醉总摄入量和平均疼痛评分相关,单侧TKA与单独的ACB相比。实施更长期的行动,用于TKA的单次ACB+IPACK可以平衡有效和更具选择性的疼痛管理与早期康复。
UNASSIGNED: To investigate if combined single-shot adductor canal blockade (ACB) and infiltration between the popliteal artery and capsule of the knee (
IPACK) provide better postoperative pain management compared to ACB alone for patients undergoing unilateral total knee arthroplasty (TKA).
UNASSIGNED: This retrospective cohort study included adult patients who underwent primary, unilateral TKA. Patients were separated into 2 cohorts: single-shot ACB alone (performed with bupivacaine 0.25%) and combined single-shot ACB +
IPACK (performed with bupivacaine 0.25%, dexmedetomidine 1 mg/kg, and dexamethasone 4 mg). Patients were propensity-matched 1:1. The primary study outcome was total opioid consumption converted to morphine milligram equivalents (MME) per eight-hour interval and postoperative day. Secondary outcomes included pain scores, length of stay, ambulation distance, return to emergency department, hospital readmission, and 30-day adverse events.
UNASSIGNED: One hundred eighty patients were identified, of which propensity matching used 71% to yield 64 patients receiving ACB alone and 64 receiving combined ACB + IPACK. Combined ACB +
IPACK had significantly lower total summative MME throughout the entire postoperative stay (P = .002) and cumulatively after the first 24 hours (P < .001). Combined ACB +
IPACK also had lower mean pain scores for 0-8 hours (P = .005) and 8-16 hours (P = .009) postoperatively. There were no significant differences in secondary outcomes.
UNASSIGNED: Combined single-shot ACB + IPACK block was associated with lower total narcotic intake and mean pain scores during most of the immediate postoperative period following primary, unilateral TKA compared to ACB alone. Implementing longer-acting, single-shot ACB +
IPACK for TKA can balance effective and more selective pain management with early rehabilitation.