Analgesic efficacy of ultrasound-guided adductor canal blockade after arthroscopic anterior cruciate ligament reconstruction A randomised controlled trial

作者：Espelund Malene^*; Fomsgaard Jonna S; Haraszuk Jorgen; Mathiesen Ole; Dahl Jorgen B

来源：European Journal of Anaesthesiology, 2013, 30(7): 422-428.

DOI：10.1097/EJA.0b013e328360bdb9

CONTEXTAnterior cruciate ligament (ACL) reconstruction surgery is associated with moderate to severe postoperative pain, which may be ameliorated by peripheral nerve blocks. The adductor canal block (ACB) is an almost exclusively sensory nerve block that has been demonstrated to reduce pain and opioid consumption after major knee surgery.OBJECTIVESTo investigate the analgesic effect of ACB in patients receiving a basic analgesic regimen of paracetamol and ibuprofen after arthroscopic ACL reconstruction under general anaesthesia.DESIGNRandomised, double-blind, placebo-controlled, parallel groups.SETTINGDay Case Surgery, University of Copenhagen, Glostrup Hospital, Denmark, June 2010 to March 2012.PATIENTSFifty patients, aged 18 to 70 years, scheduled for arthroscopic ACL reconstruction.INTERVENTIONSPatients were randomised to receive ACB with either 30ml ropivacaine 7.5mgml(-1) (n=25) or 30ml 0.9% saline (n=24).MAIN OUTCOME MEASURESPrimary outcome was pain score (0 to 100mm) during standing at 2h after surgery. Secondary outcomes were pain at rest, during standing and after walking 5m, opioid consumption and opioid-related side effects for 24h after surgery.RESULTSMedian (interquartile range) pain scores for the primary outcome were 20 (12 to 36)mm in the ropivacaine and 20 (10 to 44)mm in the control group (P=0.84, 95% confidence interval for difference of -9 to 12mm). No significant differences were observed in any of the secondary outcomes.CONCLUSIONAn analgesic regimen with paracetamol and ibuprofen provides acceptable postoperative pain control after arthroscopic ACL reconstruction. ACB did not confer further benefit in our patients.

• 出版日期2013-7