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在全膝关节整形手术中使用iPACK阻断与腰部起器脊柱平面阻断 (L-ESPB):一个随机,双盲,受控试验

Tomasz Reysner¹, Katarzyna Wieczorowska-Tobis¹, Grzegorz Kowalski¹

¹Department of Palliative Medicine, Poznań University of Medical Sciences, Poznań, Poland.

Anaesthesiology intensive therapy

|September 2, 2025

概括

与起器脊柱平面阻塞或没有阻塞相比,起器脊柱动脉和膝盖囊之间的透 (iPACK) 阻塞与附加管道阻塞 (ACB) 显著减少了阿片类药物使用和膝关节整形术 (TKA) 后的疼痛.

科学领域:

在骨科手术中进行区域麻醉和疼痛治疗.
全膝关节整形术 (TKA) 的超声指导区域阻塞.
术后疼痛控制和阿片类药物节约策略.

背景情况:

膝关节整形术 (TKA) 经常伴有严重的术后疼痛.
有效的止痛药对患者在TKA后的康复和满意度至关重要.
区域麻醉技术正在探索与TKA相关的疼痛管理.

研究的目的:

为了比较超声导向的L2勃起器脊柱平面阻塞 (L-ESPB) 与超声导向的脊柱动脉和膝盖囊间的透阻塞 (iPACK) 结合附带管道阻塞 (ACB) 在TKA后的止痛效果.
评估这些阻断对阿片类药物的总消耗,疼痛评分和其他相关临床标志物的影响.

主要方法:

在脊髓麻醉下接受TKA的90名患者被随机分为三组:iPACK+ACB,L-ESPB或对照组.
主要结局是手术后48小时内消耗的阿片类药物.
二次结局包括疼痛评分,首次救援阿片类药物的时间,四头肌强度,中性粒细胞与淋巴细胞的比率 (NLR) 和血小板与淋巴细胞的比率 (PLR).

主要成果:

与L-ESPB (6. 8 ± 3. 8) 和对照组 (18. 2 ± 4. 0) 相比,iPACK+ACB组的阿片类药物总摄入量显著降低.
在iPACK+ACB组 (12. 0±1. 9小时) 和L-ESPB组 (9. 2±1. 9小时) 和对照组 (4. 3±1. 1小时) 中,首次救援阿片类止痛的时间明显较长.
与对照组相比,iPACK+ACB和L-ESPB组的疼痛评分,NLR和PLR水平显著降低.

结论:

与TKA后的L-ESPB相比,iPACK阻断剂和ACB的组合提供了更好的止痛和阿片类药物缓解效果.
iPACK+ACB和L-ESPB都有效降低阿片类药物消耗,并延长TKA后首次阿片类药物救助止痛的时间.
虽然这两种药物都改善了疼痛控制,但NLR和PLR水平在iPACK+ACB和L-ESPB组之间没有显著差异.

关键词:

输入管道堵塞起器脊柱平面块一个 iPACK 块膝关节整形中性细胞与淋巴细胞的比率血小板与淋巴细胞的比例总数的

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