{"title":"关节镜下前交叉韧带重建术中内收肌管阻滞与腘绳肌周围浸润联合内收肌道阻滞术后镇痛的比较","authors":"Suman Saini , Neha Khattar , Divya Gautam , Nidhi Agrawal , Anju Gupta","doi":"10.1016/j.jajs.2021.03.006","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p><span>Pain after anterior cruciate ligament reconstruction (ACLR) can be attributed to both </span>arthroscopic surgery<span> and graft - donor site. Conventionally used techniques of peripheral nerve<span> blockade may not provide complete analgesia to graft - donor site. Moreover, femoral nerve blockade is known to cause quadriceps strength deficit. The purpose of this study was to evaluate whether addition of peri-hamstring infiltration to adductor canal block can lead to better analgesia after surgery than block alone.</span></span></p></div><div><h3>Methods</h3><p><span>60 ASA grade I & II patients scheduled for anterior cruciate ligament reconstruction surgery using ipsilateral hamstring autograft under </span>subarachnoid block<span> were randomly distributed into 2 groups to receive postoperatively either adductor canal block alone (group A) or peri-hamstring infiltration along with adductor canal block (group AH). Adductor canal block was given in both the groups using 15 ml of 0.5% ropivacaine<span><span> with 1:200000 adrenaline. Patients in Group AH received additional 20 ml 0.5% ropivacaine with 1:200000 adrenaline at hamstring donor site. Postoperative pain on Visual Analogue Score (VAS) at various time intervals, time to first rescue </span>analgesic requirement, cumulative analgesic requirement over 24 h, quadriceps strength, adverse effects and patient satisfaction were recorded.</span></span></p></div><div><h3>Results</h3><p><span>Statistically significant difference in mean VAS score (resting & dynamic) was observed in both the groups at 8 and 12 h (p value < 0.001). Time to first rescue analgesic was longer in group AH (11.47 ± 2.92hrs) compared to group A (8.13 ± 1.28hrs). Cumulative ketorolac requirement was lower in group AH (34 ± 18.86 mg) in contrast to group A (49 ± 20.06 mg). Quadriceps strength was comparable in both the groups and no major complications were observed in either group. However, patient satisfaction measured by </span>Numeric Rating Scale (NRS) was much better in group AH.</p></div><div><h3>Conclusion</h3><p>Peri-Hamstring infiltration of local anaesthetic along with adductor canal block is better than adductor canal block alone at allaying postoperative pain due to hamstring autograft.</p></div>","PeriodicalId":38088,"journal":{"name":"Journal of Arthroscopy and Joint Surgery","volume":"8 3","pages":"Pages 282-287"},"PeriodicalIF":0.0000,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jajs.2021.03.006","citationCount":"2","resultStr":"{\"title\":\"Comparison of combined adductor canal block with peri-hamstring infiltration versus adductor canal block for postoperative analgesia in arthroscopic anterior cruciate ligament reconstruction surgery\",\"authors\":\"Suman Saini , Neha Khattar , Divya Gautam , Nidhi Agrawal , Anju Gupta\",\"doi\":\"10.1016/j.jajs.2021.03.006\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p><span>Pain after anterior cruciate ligament reconstruction (ACLR) can be attributed to both </span>arthroscopic surgery<span> and graft - donor site. Conventionally used techniques of peripheral nerve<span> blockade may not provide complete analgesia to graft - donor site. Moreover, femoral nerve blockade is known to cause quadriceps strength deficit. The purpose of this study was to evaluate whether addition of peri-hamstring infiltration to adductor canal block can lead to better analgesia after surgery than block alone.</span></span></p></div><div><h3>Methods</h3><p><span>60 ASA grade I & II patients scheduled for anterior cruciate ligament reconstruction surgery using ipsilateral hamstring autograft under </span>subarachnoid block<span> were randomly distributed into 2 groups to receive postoperatively either adductor canal block alone (group A) or peri-hamstring infiltration along with adductor canal block (group AH). Adductor canal block was given in both the groups using 15 ml of 0.5% ropivacaine<span><span> with 1:200000 adrenaline. Patients in Group AH received additional 20 ml 0.5% ropivacaine with 1:200000 adrenaline at hamstring donor site. Postoperative pain on Visual Analogue Score (VAS) at various time intervals, time to first rescue </span>analgesic requirement, cumulative analgesic requirement over 24 h, quadriceps strength, adverse effects and patient satisfaction were recorded.</span></span></p></div><div><h3>Results</h3><p><span>Statistically significant difference in mean VAS score (resting & dynamic) was observed in both the groups at 8 and 12 h (p value < 0.001). Time to first rescue analgesic was longer in group AH (11.47 ± 2.92hrs) compared to group A (8.13 ± 1.28hrs). Cumulative ketorolac requirement was lower in group AH (34 ± 18.86 mg) in contrast to group A (49 ± 20.06 mg). Quadriceps strength was comparable in both the groups and no major complications were observed in either group. However, patient satisfaction measured by </span>Numeric Rating Scale (NRS) was much better in group AH.</p></div><div><h3>Conclusion</h3><p>Peri-Hamstring infiltration of local anaesthetic along with adductor canal block is better than adductor canal block alone at allaying postoperative pain due to hamstring autograft.</p></div>\",\"PeriodicalId\":38088,\"journal\":{\"name\":\"Journal of Arthroscopy and Joint Surgery\",\"volume\":\"8 3\",\"pages\":\"Pages 282-287\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2021-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1016/j.jajs.2021.03.006\",\"citationCount\":\"2\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Arthroscopy and Joint Surgery\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2214963521000365\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Arthroscopy and Joint Surgery","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2214963521000365","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
Comparison of combined adductor canal block with peri-hamstring infiltration versus adductor canal block for postoperative analgesia in arthroscopic anterior cruciate ligament reconstruction surgery
Background
Pain after anterior cruciate ligament reconstruction (ACLR) can be attributed to both arthroscopic surgery and graft - donor site. Conventionally used techniques of peripheral nerve blockade may not provide complete analgesia to graft - donor site. Moreover, femoral nerve blockade is known to cause quadriceps strength deficit. The purpose of this study was to evaluate whether addition of peri-hamstring infiltration to adductor canal block can lead to better analgesia after surgery than block alone.
Methods
60 ASA grade I & II patients scheduled for anterior cruciate ligament reconstruction surgery using ipsilateral hamstring autograft under subarachnoid block were randomly distributed into 2 groups to receive postoperatively either adductor canal block alone (group A) or peri-hamstring infiltration along with adductor canal block (group AH). Adductor canal block was given in both the groups using 15 ml of 0.5% ropivacaine with 1:200000 adrenaline. Patients in Group AH received additional 20 ml 0.5% ropivacaine with 1:200000 adrenaline at hamstring donor site. Postoperative pain on Visual Analogue Score (VAS) at various time intervals, time to first rescue analgesic requirement, cumulative analgesic requirement over 24 h, quadriceps strength, adverse effects and patient satisfaction were recorded.
Results
Statistically significant difference in mean VAS score (resting & dynamic) was observed in both the groups at 8 and 12 h (p value < 0.001). Time to first rescue analgesic was longer in group AH (11.47 ± 2.92hrs) compared to group A (8.13 ± 1.28hrs). Cumulative ketorolac requirement was lower in group AH (34 ± 18.86 mg) in contrast to group A (49 ± 20.06 mg). Quadriceps strength was comparable in both the groups and no major complications were observed in either group. However, patient satisfaction measured by Numeric Rating Scale (NRS) was much better in group AH.
Conclusion
Peri-Hamstring infiltration of local anaesthetic along with adductor canal block is better than adductor canal block alone at allaying postoperative pain due to hamstring autograft.
期刊介绍:
Journal of Arthroscopy and Joint Surgery (JAJS) is committed to bring forth scientific manuscripts in the form of original research articles, current concept reviews, meta-analyses, case reports and letters to the editor. The focus of the Journal is to present wide-ranging, multi-disciplinary perspectives on the problems of the joints that are amenable with Arthroscopy and Arthroplasty. Though Arthroscopy and Arthroplasty entail surgical procedures, the Journal shall not restrict itself to these purely surgical procedures and will also encompass pharmacological, rehabilitative and physical measures that can prevent or postpone the execution of a surgical procedure. The Journal will also publish scientific research related to tissues other than joints that would ultimately have an effect on the joint function.