Isaac G Freedman, Michael R Mercier, Anoop R Galivanche, Mani Ratnesh S Sandhu, Mark Hocevar, Harold Gregory Moore, Jonathan N Grauer, Lee E Rubin, Jinlei Li
{"title":"全膝关节置换术中连续内收肌窦阻滞与硬膜外麻醉的比较","authors":"Isaac G Freedman, Michael R Mercier, Anoop R Galivanche, Mani Ratnesh S Sandhu, Mark Hocevar, Harold Gregory Moore, Jonathan N Grauer, Lee E Rubin, Jinlei Li","doi":"10.2147/JPR.S462079","DOIUrl":null,"url":null,"abstract":"<p><strong>Aim: </strong>To compare the efficacy of a postoperative continuous adductor canal block (cACB) with and without a steroid adjuvant to that of epidural analgesia (EA).</p><p><strong>Methods: </strong>Patients who underwent primary total TKA at a single institution between July 2011-November 2017 were included for retrospective analysis. TKA patients were stratified into one of the three analgesia approaches: EA, cACB without steroid adjuvant, and cACB with steroid adjuvant. Hospital length of stay (LOS), discharge disposition, incidence of postoperative adverse events, and total milligram morphine equivalents (MME) requirements were compared between strata. Logistic regressions were performed to assess the independent effect of analgesia approach on prolonged LOS greater than 3 days (pLOS), non-home discharge, and total and daily MME requirements (tMME and dMME) following TKA.</p><p><strong>Results: </strong>Of the 4345 patients undergoing TKA, 1556 (35.83%) received EA, 2087 (48.03%) received cACB without steroids, and 702 (16.13%) cACB with steroids. cACB patients experienced lower rates of pLOS, higher rates of discharge to home than EA patients, and lower tMME and dMME. On multivariable analysis, cACB groups were at a lower odds of experiencing a pLOS compared to EA patients without steroids (OR = 0.64; 95% CI 0.49-0.84; with steroids: OR = 0.54; 95% CI 0.38-0.76). cACB groups had lower odds of a non-home discharge when compared to EA patients (without steroids OR = 0.42; 95% CI 0.36-0.48; with steroids: OR 0.22; 95% CI 0.18-0.27). On multivariable analysis, cACB groups required less tMME compared to the EA group (without steroids β=-290 mmE; 95% CI: -313 to -268 mmE; with steroids: β=-261 mmE; 95% CI: -289 to -233 mmE) as well as lower dMME (without steroids: β=-66 mmE/day; 95% CI -72 to -60 mmE/day; with steroids: β=-48 mmE/day; 95% CI -55 to -40 mmE/day).</p><p><strong>Conclusion: </strong>cACB was associated with greater discharge to home rates, lower rates of pLOS, and lower tMME and dMME consumption.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16661,"journal":{"name":"Journal of Pain Research","volume":null,"pages":null},"PeriodicalIF":2.5000,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11572497/pdf/","citationCount":"0","resultStr":"{\"title\":\"Continuous Adductor Canal Block Compared to Epidural Anesthesia for Total Knee Arthroplasty.\",\"authors\":\"Isaac G Freedman, Michael R Mercier, Anoop R Galivanche, Mani Ratnesh S Sandhu, Mark Hocevar, Harold Gregory Moore, Jonathan N Grauer, Lee E Rubin, Jinlei Li\",\"doi\":\"10.2147/JPR.S462079\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Aim: </strong>To compare the efficacy of a postoperative continuous adductor canal block (cACB) with and without a steroid adjuvant to that of epidural analgesia (EA).</p><p><strong>Methods: </strong>Patients who underwent primary total TKA at a single institution between July 2011-November 2017 were included for retrospective analysis. TKA patients were stratified into one of the three analgesia approaches: EA, cACB without steroid adjuvant, and cACB with steroid adjuvant. Hospital length of stay (LOS), discharge disposition, incidence of postoperative adverse events, and total milligram morphine equivalents (MME) requirements were compared between strata. Logistic regressions were performed to assess the independent effect of analgesia approach on prolonged LOS greater than 3 days (pLOS), non-home discharge, and total and daily MME requirements (tMME and dMME) following TKA.</p><p><strong>Results: </strong>Of the 4345 patients undergoing TKA, 1556 (35.83%) received EA, 2087 (48.03%) received cACB without steroids, and 702 (16.13%) cACB with steroids. cACB patients experienced lower rates of pLOS, higher rates of discharge to home than EA patients, and lower tMME and dMME. On multivariable analysis, cACB groups were at a lower odds of experiencing a pLOS compared to EA patients without steroids (OR = 0.64; 95% CI 0.49-0.84; with steroids: OR = 0.54; 95% CI 0.38-0.76). cACB groups had lower odds of a non-home discharge when compared to EA patients (without steroids OR = 0.42; 95% CI 0.36-0.48; with steroids: OR 0.22; 95% CI 0.18-0.27). On multivariable analysis, cACB groups required less tMME compared to the EA group (without steroids β=-290 mmE; 95% CI: -313 to -268 mmE; with steroids: β=-261 mmE; 95% CI: -289 to -233 mmE) as well as lower dMME (without steroids: β=-66 mmE/day; 95% CI -72 to -60 mmE/day; with steroids: β=-48 mmE/day; 95% CI -55 to -40 mmE/day).</p><p><strong>Conclusion: </strong>cACB was associated with greater discharge to home rates, lower rates of pLOS, and lower tMME and dMME consumption.</p><p><strong>Level of evidence: </strong>Level III.</p>\",\"PeriodicalId\":16661,\"journal\":{\"name\":\"Journal of Pain Research\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2024-11-13\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11572497/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Pain Research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.2147/JPR.S462079\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Pain Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2147/JPR.S462079","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的：比较术后连续内收肌阻滞（cACB）与硬膜外镇痛（EA）的疗效：纳入2011年7月至2017年11月期间在一家机构接受初级全TKA的患者进行回顾性分析。TKA患者被分为三种镇痛方法中的一种：EA、不使用类固醇辅助剂的 cACB 和使用类固醇辅助剂的 cACB。比较了不同分层的住院时间（LOS）、出院处置、术后不良事件发生率和吗啡总毫克当量（MME）需求量。进行了逻辑回归以评估镇痛方法对 TKA 术后超过 3 天的延长住院时间（pLOS）、非居家出院以及总吗啡当量和每日吗啡当量需求量（tMME 和 dMME）的独立影响：在 4345 名接受 TKA 的患者中，1556 人（35.83%）接受了 EA，2087 人（48.03%）接受了不含类固醇的 cACB，702 人（16.13%）接受了含类固醇的 cACB。与 EA 患者相比，cACB 患者的 pLOS 率较低，出院回家率较高，tMME 和 dMME 也较低。在多变量分析中，与不使用类固醇的 EA 患者相比，cACB 组患者发生 pLOS 的几率较低（OR = 0.64；95% CI 0.49-0.84；使用类固醇：OR = 0.54；95% CI 0.38-0.76）。与 EA 患者相比，cACB 组患者非居家出院的几率较低（不使用类固醇：OR = 0.42；95% CI 0.36-0.48；使用类固醇：OR = 0.22；95% CI 0.38-0.76）：或 0.22；95% CI 0.18-0.27）。多变量分析显示，与 EA 组相比，cACB 组所需的 tMME 更少（不使用类固醇时：β=-290 mmE；95% CI：-313 至 -268 mmE；使用类固醇时：β=-261 mmE；95% CI：-289 至 -233 mmE）：使用类固醇：β=-261 mmE；95% CI：-289 至 -233 mmE）以及较低的 dMME（不使用类固醇：β=-66 mmE/天；95% CI：-72 至 -60 mmE/天；使用类固醇：β=-48 mmE/天；95% CI：-55 至 -40 mmE/天）。结论：cACB与更高的出院回家率、更低的pLOS率以及更低的tMME和dMME消耗量相关：证据等级：三级。
Continuous Adductor Canal Block Compared to Epidural Anesthesia for Total Knee Arthroplasty.
Aim: To compare the efficacy of a postoperative continuous adductor canal block (cACB) with and without a steroid adjuvant to that of epidural analgesia (EA).
Methods: Patients who underwent primary total TKA at a single institution between July 2011-November 2017 were included for retrospective analysis. TKA patients were stratified into one of the three analgesia approaches: EA, cACB without steroid adjuvant, and cACB with steroid adjuvant. Hospital length of stay (LOS), discharge disposition, incidence of postoperative adverse events, and total milligram morphine equivalents (MME) requirements were compared between strata. Logistic regressions were performed to assess the independent effect of analgesia approach on prolonged LOS greater than 3 days (pLOS), non-home discharge, and total and daily MME requirements (tMME and dMME) following TKA.
Results: Of the 4345 patients undergoing TKA, 1556 (35.83%) received EA, 2087 (48.03%) received cACB without steroids, and 702 (16.13%) cACB with steroids. cACB patients experienced lower rates of pLOS, higher rates of discharge to home than EA patients, and lower tMME and dMME. On multivariable analysis, cACB groups were at a lower odds of experiencing a pLOS compared to EA patients without steroids (OR = 0.64; 95% CI 0.49-0.84; with steroids: OR = 0.54; 95% CI 0.38-0.76). cACB groups had lower odds of a non-home discharge when compared to EA patients (without steroids OR = 0.42; 95% CI 0.36-0.48; with steroids: OR 0.22; 95% CI 0.18-0.27). On multivariable analysis, cACB groups required less tMME compared to the EA group (without steroids β=-290 mmE; 95% CI: -313 to -268 mmE; with steroids: β=-261 mmE; 95% CI: -289 to -233 mmE) as well as lower dMME (without steroids: β=-66 mmE/day; 95% CI -72 to -60 mmE/day; with steroids: β=-48 mmE/day; 95% CI -55 to -40 mmE/day).
Conclusion: cACB was associated with greater discharge to home rates, lower rates of pLOS, and lower tMME and dMME consumption.
期刊介绍：
Journal of Pain Research is an international, peer-reviewed, open access journal that welcomes laboratory and clinical findings in the fields of pain research and the prevention and management of pain. Original research, reviews, symposium reports, hypothesis formation and commentaries are all considered for publication. Additionally, the journal now welcomes the submission of pain-policy-related editorials and commentaries, particularly in regard to ethical, regulatory, forensic, and other legal issues in pain medicine, and to the education of pain practitioners and researchers.
京公网安备 11010802042870号
京ICP备2023020795号-1
分享
求助内容：
应助结果提醒方式：
扫码关注我们
