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【罂粟摘要】iPACK、PAI分别联合内收肌管阻滞与单纯内收肌管阻滞在全膝关节置换术后的比较:一项随机临床试验

iPACK、PAI分别联合内收肌管阻滞与单纯内收肌管阻滞在全膝关节置换术后的比较:一项随机临床试验

贵州医科大学麻醉与心脏电生理课题组

翻译：安丽编辑：张中伟审校：曹莹

【罂粟摘要】iPACK、PAI分别联合内收肌管阻滞与单纯内收肌管阻滞在全膝关节置换术后的比较:一项随机临床试验,第4张

研究目的：腘动脉和后膝包膜之间(iPACK)的阻滞，已被认为是在不丧失肌力的情况下提供镇痛的一种有效方法，并能提供较好的术后活动功能的恢复。本研究比较了iPACK+ACB(内收肌管阻滞)与PAI(关节周围浸润)+ACB和单独ACB在术后镇痛和功能改善方面的差异。

研究方法：这项双盲随机对照试验中，纳入了接受单侧全膝关节置换术的105名患者为研究对象。患者均在蛛网膜下腔阻滞后分别接受ACB、iPACK+ACB和PAI+ACB阻滞方法。主要检测指标为48小时的曲线下面积（AUC）数值评分量表(NRS)。次要检测指标为术后48小时内的总的镇痛药物用量、下床活动情况、活动范围、住院时间、患者满意度和不良事件。

主要结果：iPACK+ACB组48小时AUC运动NRS评分显著低于PAI+ACB和ACB组（p<0.05）。术后48小时，iPACK+ACB组的阿片类药物的使用量低于ACB和PAI+ACB两组（p<0.001）。iPACK+ACB组患者的出院和活动天数明显短于ACB组和PAI+ACB各组（p<0.001）。

结论：在ACB中添加iPACK阻滞可改善术后镇痛并减少阿片类药物的用量。此外，这种方法提高了术后的功能恢复，减少了住院时间。

原始文献来源：Tayfun Et， Muhammet Korkusuz， Betül Basaran， Rafet YarımoğluHatice Toprak， Ayşegül Bilge， Nuh Kumru， İlker Dedeli.Comparison of iPACK and periarticular block with adductor block alone after total knee arthroplasty: a randomized clinical trial.Journal of Anesthesia (2022) 36:276 286.Doi.org/10.1007/s00540-022-03047-6.

英文原文

Comparison of iPACK and periarticular block with adductor block alone after total knee arthroplasty:

a randomized clinical trial

Abstract

Purpose: The infltration between the popliteal artery and the capsule of the posterior knee (iPACK) has been described to provide analgesia without loss of muscle strength and is efective in functional recovery. This study compared iPACK+ACB (adductor canal block) with PAI (periarticular infltration)+ACB and ACB alone in terms of postoperative analgesia and functional improvement.

Methods: This double-blinded randomized controlled trial included 105 patients undergoing unilateral total knee arthroplasty. Patients received ACB, iPACK+ACB, and PAI+ACB along with spinal anesthesia. The primary outcome was the area under the curve (AUC) numeric rating scale (NRS) at 48 h. Secondary outcomes were cumulative postoperative analgesic consumption within 48 h, timed up-and-go test, range of motion, length of hospital stay, patient satisfaction, and adverse events.

Results: The 48-h AUC movement NRS score in the iPACK+ACB group was signifcantly lower than in the PAI+ACB and ACB groups (p<0.05). At the postoperative 48th h, the opioid consumption of the iPACK+ACB group was lower than those of the ACB and PAI+ACB groups (p<0.001). The patients in the iPACK+ACB group had signifcantly shorter discharge and mobilization days than the ACB and PAI+ACB groups (p<0.001).

Conclusions: The adding of an iPACK block to the ACB improves postoperative analgesia and reduces opioid consumption. In addition, this approach improves functional performance and reduces hospital stay.