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Wang F, Wu J, Wu Y, Han X, Dai H, Chen Q. Different peripheral nerve blocks for patients undergoing total knee arthroplasty: a network meta-analysis of randomized controlled trials. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05507-y. [PMID: 39373765 DOI: 10.1007/s00402-024-05507-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 08/14/2024] [Indexed: 10/08/2024]
Abstract
INTRODUCTION To comprehensively compare the effect of different peripheral nerve blocks for patients undergoing total knee arthroplasty (TKA). MATERIALS AND METHODS PubMed, Embase, Cochrane Library, and Web of Science were comprehensively searched. The outcomes included postoperative pain, postoperative function, adverse events, oral morphine equivalent (OME), and perioperative indicators. Network plots, forest plots, league tables and rank probabilities were drawn for all outcomes. RESULTS Totally 30 studies were included. For postoperative pain, continuous adductor canal block (cACB) + genicular nerve block (GNB) was most likely to be the most effective block regarding rest pain score at 24 h; cACB + GNB was most likely to result in the lowest rest pain score at 48 h; patients undergoing cACB + infiltration between the popliteal artery and the capsule of the knee (IPACK) + GNB was most likely to have the lowest motion pain score at 24 h; patients undergoing cACB + GNB was most likely to have the lowest motion pain score at 48 h. For postoperative function, patients undergoing cACB + IPACK + GNB had the highest likelihood to exhibit the shortest time in Timed Up and Go test (TUG); cACB + tibial nerve block (TNB) was most likely to be the most effective block in terms of range of motion (ROM); cACB + IPACK was most likely to be the optimal block concerning the ambulation distance. CONCLUSION cACB combined with IPACK/GNB may be the most favorable block after TKA, continuous blocks may be better than single-shot blocks, and combined blocks may be better than separate blocks.
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Affiliation(s)
- Faxing Wang
- Department of Anesthesiology, Lishui People's Hospital, Lishui Hospital of Wenzhou Medical University, No. 1188 Liyang Street, Lishui, Zhejiang, 323000, People's Republic of China
| | - Jimin Wu
- Department of Anesthesiology, Lishui People's Hospital, Lishui Hospital of Wenzhou Medical University, No. 1188 Liyang Street, Lishui, Zhejiang, 323000, People's Republic of China
| | - Yini Wu
- Department of Anesthesiology, Lishui People's Hospital, Lishui Hospital of Wenzhou Medical University, No. 1188 Liyang Street, Lishui, Zhejiang, 323000, People's Republic of China
| | - Xin Han
- Department of Anesthesiology, Lishui People's Hospital, Lishui Hospital of Wenzhou Medical University, No. 1188 Liyang Street, Lishui, Zhejiang, 323000, People's Republic of China
| | - Hong Dai
- Department of Anesthesiology, Lishui People's Hospital, Lishui Hospital of Wenzhou Medical University, No. 1188 Liyang Street, Lishui, Zhejiang, 323000, People's Republic of China
| | - Qin Chen
- Department of Anesthesiology, Lishui People's Hospital, Lishui Hospital of Wenzhou Medical University, No. 1188 Liyang Street, Lishui, Zhejiang, 323000, People's Republic of China.
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Dhumey T, Bhalerao N, Paul A, Wanjari D. Adductor Canal Block Versus Femoral Nerve Block for Postoperative Pain Management in Anterior Cruciate Ligament Reconstruction: A Prospective Interventional Study. Cureus 2024; 16:e64625. [PMID: 39149628 PMCID: PMC11325116 DOI: 10.7759/cureus.64625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Accepted: 07/15/2024] [Indexed: 08/17/2024] Open
Abstract
Background A common knee joint disorder is injury to the anterior cruciate ligament (ACL), which often requires surgery. Proper pain control after the surgery facilitates fast recovery and prevents chronic pain. To provide analgesia for knee procedures, the use of opioids, non-steroidal anti-inflammatory medications, and regional techniques are commonly employed. This study aims to evaluate the efficacy of adductor canal block (ACB) and femoral nerve block (FNB) for postoperative pain management after anterior cruciate ligament reconstructions (ACLRs). Methodology This prospective interventional study included 30 participants scheduled for patellar graft ACLR. They were assigned into groups, i.e., ACB and FNB, with 15 patients each. The evaluation occurred one day before the operation, and all surgical procedures were performed using spinal anesthesia. During the postoperative period, a 10-point visual analog scale (VAS) was utilized to quantify pain intensity at the end of the surgery and at various intervals after the surgery. Patients with a VAS score greater than 4 received either FNB or ACB using bupivacaine 0.125%. Duration of analgesia time, power of quadriceps muscle, and neurologic complications were documented. Results No statistically significant value was observed in the mean duration of analgesia between the patients in ACB (348.33 minutes) and the patients in FNB (363.06 minutes). No motor block was observed in 12 patients who received ACB, while only four patients had a motor-sparing effect among those who received FNB. No neurological adverse effects were observed in the study participants. Conclusions ACB provides an equal duration of analgesia similar to FNB, and ACB significantly spares motor strength and maintains higher quadriceps power than FNB.
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Affiliation(s)
- Tapan Dhumey
- Anaesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nikhil Bhalerao
- Anaesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Amreesh Paul
- Anaesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Dnyanshree Wanjari
- Anaesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Wan D, Wang R, Wei J, Zan Q, Shang L, Ma J, Yao S, Xu C. Bibliometric and visual analysis of research on analgesia and total knee arthroplasty from 1990 to 2022. Heliyon 2024; 10:e25153. [PMID: 38322956 PMCID: PMC10844279 DOI: 10.1016/j.heliyon.2024.e25153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 01/21/2024] [Accepted: 01/22/2024] [Indexed: 02/08/2024] Open
Abstract
Background In recent decades, there have been notable advancements in the field of analgesia and total knee arthroplasty (TKA). This study aims to employ bibliometric analysis to elucidate the prevailing research focal points and trends within analgesia and TKA from 1990 to 2022. Material and methods Relevant publications were retrieved from the Web of Science Core Collection. CiteSpace, VOSviewer, and Scimago Graphica were used for visualization and bibliometric analysis of countries, institutions, authors, journals, references, and keywords. Results A total of 2776 publications on analgesia and TKA were identified, with the United States having the highest number of publications. The University of Copenhagen was the most productive institution, and Kehlet, Henrik was the most prolific author. The Journal of Arthroplasty had the most publications and citations. The most common keywords were "TKA," "pain management," "postoperative pain," "Total hip arthroplasty (THA)," and "postoperative management." Keyword burst detection demonstrated that adductor canal block (ACB) was a recent research hotspot. Conclusion Our study revealed a sharp increase in global publications on analgesia and TKA, and this trend is expected to continue. Further research is necessary to determine the optimal regimen for multimodal analgesia, the ideal location and volume of ACB, and their clinical significance.
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Affiliation(s)
- Dongping Wan
- Department of Knee Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
- The First Clinical Medical College, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Rui Wang
- The First Clinical Medical College, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Jie Wei
- State Key Laboratory of Cancer Biology, Department of Pathology, The First Affiliated Hospital of Air Force Military Medical University, Xi’an, China
| | - Qiang Zan
- The First Clinical Medical College, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Lei Shang
- Department of Health Statistics, Faculty of Preventive Medicine, The Air Force Military Medical University, Xi’an, China
| | - Jianbing Ma
- Department of Knee Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Shuxin Yao
- Department of Knee Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Chao Xu
- Department of Knee Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
- Department of Health Statistics, Faculty of Preventive Medicine, The Air Force Military Medical University, Xi’an, China
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Zhang J, Che J, Sun X, Ren W. Clinical Application of Perioperative Anaesthesia Management Based on Enhanced Recovery after Surgery Concept to Elderly Patients Undergoing Total Knee Replacement. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:8039358. [PMID: 35392043 PMCID: PMC8983202 DOI: 10.1155/2022/8039358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/07/2022] [Accepted: 03/15/2022] [Indexed: 11/29/2022]
Abstract
Objective To explore the clinical application effect of perioperative anesthesia management based on enhanced recovery after surgery (ERAS) concept to elderly patients undergoing total knee replacement (TKR). Methods By means of retrospective analysis, the medical data of elderly patients undergoing TKR treated in our hospital (02, 2019-02, 2020) were analyzed, and 100 patients were selected as the study objects according to the inclusion and exclusion criteria and divided into the study group (SG) and reference group (RG) according to their admission order, with 50 cases each. Patients in SG received perioperative anesthesia management based on ERAS concept, and those in RG accepted routine perioperative anesthesia management, so as to compare the perioperative inflammatory factors levels, postoperative recovery indicators, and postoperative Numeric Rating Scale (NRS) scores between the two groups. Results Compared with RG after surgery, SG obtained significantly lower inflammatory factors levels (P < 0.001) and significantly better recovery indicators (P < 0.05), and the pain scores at postoperative 12 h and 24 h of SG were, respectively (1.46 ± 0.67) points and (2.00 ± 0.45) points, which were significantly lower than those of RG (P < 0.05). Conclusion Perioperative anesthesia management based on EARS concept can improve the perioperative indicators of elderly patients undergoing TKR, result in less postoperative pain, and obtain a more desirable recovery.
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Affiliation(s)
- Jizheng Zhang
- Department of Anesthesiology, Outpatient and Emergency,Tianjin Hospital, Tianjin 300211, China
| | - Jinli Che
- Department of Anesthesiology, Outpatient and Emergency,Tianjin Hospital, Tianjin 300211, China
| | - Xiaohua Sun
- Department of Anesthesiology, Outpatient and Emergency,Tianjin Hospital, Tianjin 300211, China
| | - Wanlu Ren
- Department of Anesthesiology, Outpatient and Emergency,Tianjin Hospital, Tianjin 300211, China
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