腘动脉-膝关节后囊间隙阻滞与关节周围注射对全膝关节置换术后镇痛效果的meta分析

Infiltration Between the Popliteal Artery and the Capsule of the Posterior Knee Block Versus Periarticular Injection for Analgesia After Total Knee Arthroplasty: a Meta-analysis

目的评价腘动脉-膝关节后囊间隙(infiltration between the popliteal artery and the capsule of the posterior knee,iPACK)阻滞对比关节周围注射(periarticular injection,PAI)在全膝关节置换(total knee arthroplasty,TKA)术后镇痛中的作用。方法检索PubMed、EMBASE、Web of Science、中国生物医学文献数据库(CBM)、中文科技期刊全文数据库(VIP)、中国期刊全文数据库(CNKI)及万方数据库中iPACK对比PAI对TKA术后镇痛的随机对照试验(RCT),时间均从建库至2021年12月。2位研究者按照纳入标准筛选文献、提取资料,2位评价员独立对纳入文献的质量进行评价,采用RevMan5.3进行meta分析。结果纳入6个RCT共440例患者。与PAI相比,iPACK组术后24 h吗啡累积使用量较少(MD=-4.21,95%CI:-7.18~-1.24,P=0.005),术后12 h运动状态和24、48 h静息状态、运动状态下疼痛视觉模拟评分(Visual Analogue Scale,VAS)降低,差异有统计学意义(P<0.05),术后12 h静息状态VAS差异无统计学意义(P>0.05);2组术后第1天、第2天行走距离相当,差异无统计学意义(P>0.05)。结论与PAI相比,iPACK阻滞能更有效地减轻TKA术后疼痛,减少阿片类药物用量,不影响术后活动,用于TKA术后镇痛安全有效。

Objective To compare the analgesic effects of ultrasound-guided infiltration between the popliteal artery and the capsule of the posterior knee(iPACK)block versus periarticular injection(PAI)in patients undergoing total knee arthroplasty(TKA).Methods The PubMed database,EMBASE,Web of Science,CBM database,VIP database,CNKI database and Wanfang database were searched from their start year up to December 2021 for randomized clinical trials(RCT)that comparing iPACK block with PAI for postoperative analgesia after TKA.Two independent reviewers screened the identified articles against the inclusion criteria and extracted relevant information from the included studies.Two independent reviewers evaluated the methodological quality of the included studies.A meta-analysis was conducted by using the RevMan 5.3 software.Results Six RCTs involving 440 patients were included in this meta-analysis.Compared with patients in the PAI group,patients in the iPACK group showed lower 24 h postoperative opioids consumption(MD=-4.21,95%CI:-7.18~-1.24,P=0.005),and had lower Visual Analogue Scale(VAS)pain scores at 12 h during movement,and 24 h,48 h at rest and during movement after TKA(P<0.05).There was no difference in the VAS pain scores at 12 h at rest(P>0.05).There was no difference in the walking distance in the first and second postoperative day(P>0.05).Conclusions Compared with PAI,iPACK block results in lower pain scores and lower opioids consumption after TKA,and does not affect postoperative activities.It is safe and effective for postoperative analgesia after TKA.