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朱 光, 邹 丽, 金 群. [Comparison of the effects of sciatic nerve block combined with continuted femoral nerve block or continuted adductor canal block on pain and motor function after total knee arthroplasty]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2024; 38:556-561. [PMID: 38752241 PMCID: PMC11096886 DOI: 10.7507/1002-1892.202402048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/19/2024] [Indexed: 05/18/2024]
Abstract
Objective To compare the effect of sciatic nerve block (SNB) combined with continuted femoral nerve block (FNB) or continuted adductor canal block (ACB) on pain and motor function after total knee arthroplasty (TKA). Methods A total of 60 patients with TKA-treated osteoarthritis of the knee who met the selection criteria were enrolled between November 2020 and February 2021 and randomised allocated into the study group (SNB combined with continuted ACB) and the control group (SNB combined with continuted FNB), with 30 cases in each group. There was no significant difference in gender, age, body mass, height, body mass index, preoperative Hospital for Special Surgery (HSS) score, femoral tibial angle, and medial proximal tibial angle between the two groups ( P>0.05). The operation time, the initial time to the ground, the initial walking distance, and the postoperative hospital stay were recorded. At 2, 4, 6, 12, 24, and 48 hours after operation, the numerical rating scale (NRS) score was used to evaluate the rest pain around the knee joint, the quadriceps femoris muscle strength was evaluated by the freehand muscle strength method, and the knee flexion and extension angles were measured. Results There was no significant difference in the operation time and initial walking distance between the two groups ( P>0.05); the initial time to the ground and postoperative hospital stay of the study group were significantly shorter than those of the control group ( P<0.05). Except for the 48-hour postoperative NRS score of the study group, which was significantly lower than that of the control group ( P<0.05), there was no significant difference in the NRS scores between the two groups at the remaining time points ( P>0.05). The quadriceps femoris muscle strength from 4 to 24 hours postoperatively and the knee extension angle from 2 to 6 hours postoperatively of the study group were significantly better than those of the control group ( P<0.05); the differences in the quadriceps femoris muscle strength and knee extension and flexion angles between the two groups at the remaining time points were not significant ( P>0.05). Conclusion SNB combined with either continuted ACB or continuted FNB can effectively relieve pain in patients after TKA, and compared with combined continuted FNB, combined continuted ACB has less effect on quadriceps femoris muscle strength, and patients have better recovery of knee flexion and extension mobility.
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Affiliation(s)
- 光 朱
- 宁夏医科大学临床医学院(银川 750001)School of Clinical Medicine, Ningxia Medical University, Yinchuan Ningxia, 750001, P. R. China
| | - 丽丽 邹
- 宁夏医科大学临床医学院(银川 750001)School of Clinical Medicine, Ningxia Medical University, Yinchuan Ningxia, 750001, P. R. China
| | - 群华 金
- 宁夏医科大学临床医学院(银川 750001)School of Clinical Medicine, Ningxia Medical University, Yinchuan Ningxia, 750001, P. R. China
- 宁夏医科大学总医院麻醉科(银川 750001)Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan Ningxia, 750001, P. R. China
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Kuo YF, Kim E, Westra J, Wilkes D, Raji MA. Pain Control Associated With Gabapentinoid Prescription After Elective Total Knee Arthroplasty. J Arthroplasty 2024; 39:941-947.e1. [PMID: 37871858 DOI: 10.1016/j.arth.2023.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/09/2023] [Accepted: 10/14/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Gabapentinoid (GABA) prescribing has substantially increased as a nonopioid analgesics for surgical conditions. We examined the effectiveness of GABA use for postoperative pain control among patients receiving total knee arthroplasty (TKA). METHODS This retrospective cohort study using 2016 to 2019 data from a 20% national sample of Medicare enrollees included patients aged 66 and over years who received an elective TKA, were discharged to home, received home health care, and had both admission and discharge assessments of pain (n = 35,186). Study outcomes were pain score difference between admission and discharge and less-than-daily pain interfering with activity at discharge. Opioid and GABA prescriptions after surgery and receipt of nerve block within 3 days of surgery were also assessed. RESULTS There were 30% of patients who had a pain score decrease of 3 to 4 levels and 55.8% had pain score decreases of 1 to 2 levels. In multivariable analyses, receiving a nerve block was significantly associated with pain score reduction. A GABA prescription increased the magnitude of pain score reduction among those receiving a nerve block. Results from inverse probability weighted analysis with propensity score showed that coprescribing of GABA and low-dose opioid was associated with significantly lower pain scores. CONCLUSIONS Post-TKA opioid use was not associated with pain score reduction. Receiving a nerve block was associated with a modest pain score reduction. Co-prescribing GABA with low-dose opioid or receiving a nerve block was associated with increasing magnitudes of pain reduction. Further research should identify alternatives to opioid use for managing postoperative TKA pain.
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Affiliation(s)
- Yong-Fang Kuo
- Division of Geriatrics and Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas; Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas; Department of Biostatistics & Data Science, University of Texas Medical Branch, Galveston, Texas; Office of Biostatistics, University of Texas Medical Branch, Galveston, Texas
| | - Emily Kim
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Jordan Westra
- Office of Biostatistics, University of Texas Medical Branch, Galveston, Texas
| | - Denise Wilkes
- Department and Anesthesiology, University of Texas Medical Branch, Galveston, Texas
| | - Mukaila A Raji
- Division of Geriatrics and Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas; Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas
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Upshaw WC, Richey JM, Tassin JP, Frolov MV, Miller BC, Kaye AJ, Sterritt J, Fox CJ, Ahmadzadeh S, Shekoohi S, Kaye AD. IPACK Block Efficacy for Acute Pain Management after Total Knee Replacement: A Review. Curr Pain Headache Rep 2024:10.1007/s11916-024-01237-3. [PMID: 38520494 DOI: 10.1007/s11916-024-01237-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE OF REVIEW Patients often experience a significant degree of knee pain following total knee replacement (TKR). To alleviate this pain, nerve blocks may be performed such as the adductor canal block (ACB). However, ACBs are unable to relieve pain originating from the posterior region of the knee. A new type of nerve block known as the IPACK block may be used in conjunction with ACBs as it is designed to inhibit nerve branches innervating this area. In this article, we examine the rationale behind the IPACK procedure, how it is performed, and clinical trials examining its efficacy. RECENT FINDINGS 5 of the 7 clinical trials examined in this article showed the IPACK + ACB block to show superior efficacy in treating pain following TKR compared to other blocks. These blocks included PMDI+ACB, SPANK+ACB, PAI+ACB, ACB alone, and SCAB. 2 of the 7 clinical trials showed the IPACK + ACB to be less effective in managing patients pain following TKR compared to other blocks which included the CACB and 4 in 1 block. In most instances, the IPACK + ACB showed superior efficacy in managing patients' pain following TKR when compared to other types of nerve blocks. This was determined by measuring usage of opioids, reported postoperative pain, and length of hospital stays following TKR. Thus, we suppose the IPACK block may be used in conjunction with the ACB to effectively reduce patient's pain following TKR.
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Affiliation(s)
- William C Upshaw
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA
| | - John M Richey
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA
| | - Joseph P Tassin
- School of Dentistry, Louisiana State University Health Science Center, New Orleans, LA, 70119, USA
| | - Mark V Frolov
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA
| | - Benjamin C Miller
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Aaron J Kaye
- WakeMed Anesthesia, 3000 New Bern Ave, Raleigh, NC, 27610, USA
| | - Jeffrey Sterritt
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Charles J Fox
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Shahab Ahmadzadeh
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Alan D Kaye
- Department of Anesthesiology, Department of Pharmacology, Toxicology, and Neurosciences, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA
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Yun HJ, Kim JB, Chung HS. Predictive Ability of Perfusion Index for Determining the Success of Adductor Canal Nerve Block for Postoperative Analgesia in Patients Undergoing Unilateral Total Knee Arthroplasty. Life (Basel) 2023; 13:1865. [PMID: 37763269 PMCID: PMC10532524 DOI: 10.3390/life13091865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 08/30/2023] [Accepted: 09/02/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The perfusion index (PI) is an objective method used to determine a successful nerve block. This study aimed to investigate the prognostic ability of the PI for a successful adductor canal nerve block (ACB) and suggest the optimal PI cut-off value for predicting a block. METHODS This study was a prospective observational study and enrolled a total of 39 patients. The patients were dichotomized into successful and inappropriate ACB groups according to the results of the sensation tests. The PI value, Pleth variability index (PVi) value, and heart rate were recorded one minute before the block, at the time of the block, and one to 30 min after the block at one-minute intervals. Delta (dPI), which was defined as the difference in PI value from the baseline (the value one minute before the block), was the primary outcome. The area under the receiver operating characteristic curve (AUROC) was calculated to determine the dPI prognostic accuracy and optimal cut-off value. RESULTS Successful ACB was achieved in 33 patients, while ACB was inappropriate in six patients. The dPI showed significant differences between the two groups under the time interval measured (p = 0.001). The dPI at 5 and 20 min showed good prognostic ability for a successful block, with optimal cut-off values of 0.33 (AUROC: 0.725, 95% CI 0.499-0.951) and 0.64 (AUROC: 0.813, 95% CI 0.599-1.000), respectively. CONCLUSIONS The dPI is an effective predictor of successful ACB. The suggested dPI cut-off values at 5 and 20 min were below 0.33 and 0.64, respectively.
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Affiliation(s)
| | | | - Hyun Sik Chung
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea
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