全膝关节置换后股神经阻滞和收肌管阻滞镇痛的Meta分析

Analgesic effect of femoral nerve block versus adductor canal block after total knee arthroplasty: a meta-analysis

背景:近年来随着对全膝关节置换后疼痛控制的广泛研究发现了不同的镇痛方式。其中股神经阻滞因可有效控制疼痛而作为全膝关节置换后镇痛的标准方法,但其可能减低置换后股四头肌肌力而造成严重后果。收肌管阻滞是一种新兴的镇痛方式,其在全膝关节置换后具有更快的功能恢复及良好的疼痛控制能力。目的:应用Meta分析方法对比全膝关节置换后收肌管阻滞和股神经阻滞在疼痛控制和功能恢复等方面的差异。方法:以2017年3月为截点,在万方数据库、维普数据库、中国知网、Pub Med、Web of Science、Embase数据库中检索关于膝关节置换镇痛和功能恢复的相关文献,按Cochrane系统评价方法筛选,纳入文献采用Cochrane协作网提供的Revman 5.1软件进行统计学分析。结果与结论:(1)最终纳入12篇文献,共802例患者,总计872膝;(2)分析显示,与股神经阻滞相比,收肌管阻滞可明显地减低术后8 h静息目测类比评分(P<0.001),并且可以改善股四头肌肌力(P<0.001)和活动能力(TUG试验)(P<0.05);但是术后24,48 h静息目测类比评分和术后8,24,48 h动态目测类比评分、阿片类药物使用量、住院时间方面2组差异并无显著性意义;(3)综上,膝关节置换后收肌管阻滞使患者早期(术后8 h)镇痛效果更好,具有更好的活动能力和更强的股四头肌肌力,因此收肌管阻滞在膝关节置换后可作为替代股神经阻滞的一种镇痛方式。

BACKGROUND:In recent years,extensive studies on the pain management after total knee arthroplasty(TKA)have identified different ways of analgesia.Among which,femoral nerve block(FNB)is the standard antalgic method post-TKA for its effective analgesia,but it may reduce the muscle strength of the quadriceps after TKA and cause serious consequences.Adductor canal block(ACB)is a novel antalgic method that provides fast functional recovery and good ability of pain control after TKA.OBJECTIVE:To compare the functional recovery and ability of pain control of ACB and FNB after TKA through a meta-analysis.METHODS:Databases of WanFang,CNKI,PubMed,Web of Science,and Embase were searched for the literature concerning the analgesia and functional recovery after TKA published before March 2017.The articles were evaluated according to the Cochrane system and a meta-analysis was conducted on Revman 5.1.RESULTS AND CONCLUSION:(1)Twelve articles were included involving 802 patients with 872 knees.(2)Meta-analysis results showed that compared with FNB,ACB significantly reduced the Visual Analogue Scale scores at rest at 8 hours postoperatively(P<0.001)and significantly improved the muscle strength of quadriceps femoris(P<0.001)and motor capacity(Timed Up and Go test)(P<0.05);but the scores at rest at 24 and 48 hours postoperatively,and the scores in activity at postoperative different time points,usage of opioids,and hospitalization time did not differ significantly between two groups.(3)ACB can achieve better analgesia at the early period(8 hours)after TKA,better motor capacity and stronger muscle strength of the quadriceps femoris;thereafter,it is a substitute for FNB after TKA.