4-in-1阻滞与股神经阻滞及收肌管阻滞在关节镜下ACL重建术中的比较：一项RCT
简介
这项随机对照试验将60例关节镜下ACL重建患者随机分为4-in-1阻滞、股神经阻滞（FNB）和收肌管阻滞（ACB）三组，超声引导下注射20 mL 0.25%布比卡因。结果显示，三组术中瑞芬太尼用量、术后24小时静脉吗啡等效剂量及0-24小时NRS曲线下面积均无显著差异。4-in-1阻滞在ACL重建围手术期镇痛中与FNB或ACB无显著差异，尚需进一步研究。
英文摘要
OBJECTIVES: The aim of this study was to compare the 4-in-1 block technique with femoral nerve block (FNB) and adductor canal block (ACB) in terms of perioperative pain and opioid consumption in patients undergoing arthroscopic anterior cruciate ligament reconstruction (ACLR). METHODS: The trial was retrospectively registered. In this randomized controlled trial, patients scheduled for ACLR under general anesthesia were randomly assigned to one of three groups: 4-in-1 block, FNB, or ACB. All blocks were performed under ultrasound guidance with 20 mL of 0.25% bupivacaine approximately 45 min before surgery. Intraoperative remifentanil use, postoperative 24-hour intravenous morphine equivalents (IME) consumption, and pain scores measured by the numerical rating scale (NRS) were recorded. Overall postoperative pain burden was additionally assessed using the 0-24-hour NRS area under the curve (AUC). An exploratory post-hoc non-inferiority analysis was performed. RESULTS: A total of 60 patients were equally divided among the groups. Intraoperative remifentanil consumption, postoperative 24-hour IME consumption, and the 0-24-hour NRS AUC values did not differ significantly among the groups (p = 0.842, p = 0.502, and p = 0.958, respectively). Compared with the ACB group, the 4-in-1 block group used, on average, 0.8 mg less postoperative 24-hour IME (90% confidence interval [CI], - 5.61-4.01). Compared with the FNB group, 24-hour IME use was 2.8 mg greater (90% CI, - 1.48-7.08). In both comparisons, the upper bounds of the two-sided 90% CIs did not exceed the exploratory post-hoc non-inferiority margin (Δ = 10 mg). CONCLUSION: In patients undergoing ACLR, the 4-in-1 block did not differ significantly from FNB or ACB in terms of analgesic outcomes. These exploratory findings require further investigation to clarify the role of the 4-in-1 block in perioperative pain management for ACLR. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT05643040. Registered 23 November 2022. Retrospectively registered.