{"title":"全膝关节置换术后腘窝神经丛阻滞对腘动脉与膝后阻滞联合股三角阻滞的镇痛效果：一项随机非劣效性试验和尸体评价。","authors":"Takashi Fujino, Keiko Taga, Masahiko Odo, Hidaka Anetai, Haruka Kaneko, Saki Uchiyama, Mitsuaki Kubota, Yoshitomo Saita, Keiichi Yoshida, Shinnosuke Hada, Youngji Kim, Jun Shiozawa, Koichiro Ichimura, Muneaki Ishijima, Izumi Kawagoe","doi":"10.1136/rapm-2025-106895","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Both popliteal plexus block and infiltration between the popliteal artery and capsule of the posterior knee (IPACK) block can alleviate posterior knee pain after total knee arthroplasty (TKA) while preserving motor function. We aimed to assess whether popliteal plexus block is non-inferior to IPACK block in reducing posterior knee pain after TKA.</p><p><strong>Methods: </strong>Eighty-six participants undergoing elective TKA were randomized to receive popliteal plexus block or IPACK block combined with femoral triangle block. The primary outcome was moderate-to-severe posterior knee pain at eight postoperative hours. Secondary outcomes included pain scores, fentanyl consumption, sensorimotor function, range of motion, block performance time, quality of recovery, and participant satisfaction. Injectate spread in popliteal plexus block was also assessed in seven cadaveric legs.</p><p><strong>Results: </strong>The lower bound of the 90% CI for the between-group difference (IPACK - popliteal plexus block) in moderate-to-severe posterior knee pain did not exceed the 17% non-inferiority margin (difference=4.7, (90% CI -5.6 to 14.9; p<0.001)), demonstrating that popliteal plexus block was non-inferior to IPACK block. The block performance time (median (IQR)) was significantly shorter in the popliteal plexus block group (3 (3-5) min) than in the IPACK group (5 (5-6) min; p<0.0001). No significant difference in the preservation of motor function was observed. The posterior articular branches were stained in all the cadaveric specimens.</p><p><strong>Conclusions: </strong>Compared with the IPACK block, popliteal plexus block provides non-inferior posterior knee analgesia following TKA while maintaining ankle muscle strength, with the additional advantage of having a shorter block performance time.</p><p><strong>Trial registration number: </strong>UMIN000052472; URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000059848.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5000,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Analgesic efficacy of popliteal plexus block versus infiltration between the popliteal artery and capsule of the posterior knee block combined with femoral triangle block after total knee arthroplasty: a randomized non-inferiority trial and cadaveric evaluation.\",\"authors\":\"Takashi Fujino, Keiko Taga, Masahiko Odo, Hidaka Anetai, Haruka Kaneko, Saki Uchiyama, Mitsuaki Kubota, Yoshitomo Saita, Keiichi Yoshida, Shinnosuke Hada, Youngji Kim, Jun Shiozawa, Koichiro Ichimura, Muneaki Ishijima, Izumi Kawagoe\",\"doi\":\"10.1136/rapm-2025-106895\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Both popliteal plexus block and infiltration between the popliteal artery and capsule of the posterior knee (IPACK) block can alleviate posterior knee pain after total knee arthroplasty (TKA) while preserving motor function. We aimed to assess whether popliteal plexus block is non-inferior to IPACK block in reducing posterior knee pain after TKA.</p><p><strong>Methods: </strong>Eighty-six participants undergoing elective TKA were randomized to receive popliteal plexus block or IPACK block combined with femoral triangle block. The primary outcome was moderate-to-severe posterior knee pain at eight postoperative hours. Secondary outcomes included pain scores, fentanyl consumption, sensorimotor function, range of motion, block performance time, quality of recovery, and participant satisfaction. Injectate spread in popliteal plexus block was also assessed in seven cadaveric legs.</p><p><strong>Results: </strong>The lower bound of the 90% CI for the between-group difference (IPACK - popliteal plexus block) in moderate-to-severe posterior knee pain did not exceed the 17% non-inferiority margin (difference=4.7, (90% CI -5.6 to 14.9; p<0.001)), demonstrating that popliteal plexus block was non-inferior to IPACK block. The block performance time (median (IQR)) was significantly shorter in the popliteal plexus block group (3 (3-5) min) than in the IPACK group (5 (5-6) min; p<0.0001). No significant difference in the preservation of motor function was observed. The posterior articular branches were stained in all the cadaveric specimens.</p><p><strong>Conclusions: </strong>Compared with the IPACK block, popliteal plexus block provides non-inferior posterior knee analgesia following TKA while maintaining ankle muscle strength, with the additional advantage of having a shorter block performance time.</p><p><strong>Trial registration number: </strong>UMIN000052472; URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000059848.</p>\",\"PeriodicalId\":54503,\"journal\":{\"name\":\"Regional Anesthesia and Pain Medicine\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.5000,\"publicationDate\":\"2025-08-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Regional Anesthesia and Pain Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1136/rapm-2025-106895\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Regional Anesthesia and Pain Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/rapm-2025-106895","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：腘窝神经丛阻滞和腘动脉与膝后囊浸润（IPACK）阻滞均可减轻全膝关节置换术（TKA）后膝关节后侧疼痛，同时保留运动功能。我们的目的是评估在减轻TKA后膝关节后部疼痛方面，腘神经丛阻滞是否优于IPACK阻滞。方法：86例选择性TKA患者随机接受腘丛阻滞或IPACK阻滞联合股三角阻滞。术后8小时的主要结局是中度至重度膝关节后疼痛。次要结局包括疼痛评分、芬太尼用量、感觉运动功能、运动范围、阻滞时间、恢复质量和参与者满意度。在7条尸体腿上也评估了腘神经丛阻滞的注射扩散。结果：组间差异（IPACK -腘神经丛阻滞）的90% CI下界不超过17%的非劣效性边界(差异=4.7,(90% CI -5.6 ~ 14.9；结论：与IPACK阻滞相比，腘丛阻滞在维持踝关节肌力的同时提供TKA后非下位膝关节镇痛，并具有阻滞时间更短的优势。试验注册号：UMIN000052472；URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000059848。
Analgesic efficacy of popliteal plexus block versus infiltration between the popliteal artery and capsule of the posterior knee block combined with femoral triangle block after total knee arthroplasty: a randomized non-inferiority trial and cadaveric evaluation.
Background: Both popliteal plexus block and infiltration between the popliteal artery and capsule of the posterior knee (IPACK) block can alleviate posterior knee pain after total knee arthroplasty (TKA) while preserving motor function. We aimed to assess whether popliteal plexus block is non-inferior to IPACK block in reducing posterior knee pain after TKA.
Methods: Eighty-six participants undergoing elective TKA were randomized to receive popliteal plexus block or IPACK block combined with femoral triangle block. The primary outcome was moderate-to-severe posterior knee pain at eight postoperative hours. Secondary outcomes included pain scores, fentanyl consumption, sensorimotor function, range of motion, block performance time, quality of recovery, and participant satisfaction. Injectate spread in popliteal plexus block was also assessed in seven cadaveric legs.
Results: The lower bound of the 90% CI for the between-group difference (IPACK - popliteal plexus block) in moderate-to-severe posterior knee pain did not exceed the 17% non-inferiority margin (difference=4.7, (90% CI -5.6 to 14.9; p<0.001)), demonstrating that popliteal plexus block was non-inferior to IPACK block. The block performance time (median (IQR)) was significantly shorter in the popliteal plexus block group (3 (3-5) min) than in the IPACK group (5 (5-6) min; p<0.0001). No significant difference in the preservation of motor function was observed. The posterior articular branches were stained in all the cadaveric specimens.
Conclusions: Compared with the IPACK block, popliteal plexus block provides non-inferior posterior knee analgesia following TKA while maintaining ankle muscle strength, with the additional advantage of having a shorter block performance time.
期刊介绍：
Regional Anesthesia & Pain Medicine, the official publication of the American Society of Regional Anesthesia and Pain Medicine (ASRA), is a monthly journal that publishes peer-reviewed scientific and clinical studies to advance the understanding and clinical application of regional techniques for surgical anesthesia and postoperative analgesia. Coverage includes intraoperative regional techniques, perioperative pain, chronic pain, obstetric anesthesia, pediatric anesthesia, outcome studies, and complications.
Published for over thirty years, this respected journal also serves as the official publication of the European Society of Regional Anaesthesia and Pain Therapy (ESRA), the Asian and Oceanic Society of Regional Anesthesia (AOSRA), the Latin American Society of Regional Anesthesia (LASRA), the African Society for Regional Anesthesia (AFSRA), and the Academy of Regional Anaesthesia of India (AORA).
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