ARTHROPLASTY
Adductor canal block for postoperative pain treatment after revision knee arthroplasty: a blinded, randomized, placebo-controlled study
This report has been verified
by one or more authors of the
original publication.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2015;3(4):4 PLoS One. 2014 Nov 11;9(11):e11195136 patients scheduled to undergo revision total knee arthroplasty were randomly assigned to adductor canal block with ropivacaine or placebo. The purpose of this study was to evaluate whether an adductor canal block reduced postoperative pain to a significant degree. The primary outcome of interest was VAS pain during knee flexion at 4 hours postoperatively. Results indicated a significantly greater reduction in pain at 4 hours postoperatively in the adductor canal block group than the placebo group. However, due to a large dropout rate, the findings from this trial alone cannot support the use of adductor canal block for the management of postoperative pain after revision total knee arthroplasty.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
はい = 1
不確実＝0.5
無関係 = 0
いいえ = 0
報告基準評価では、著者が出版物内で試験の方法論的特徴や試験特性を報告する際の透明性を評価します。評価は以下の5つのカテゴリーに分類されます。
4/4
Randomization
3/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Fragility Indexは、重要な所見の解釈を助けるツールで、結果の強さの尺度を提供します。Fragility Indexは、その所見が有意でなくなるために、二項対立の結果に追加する必要がある連続した事象の数を表します。数値が小さいほど弱い所見を表し、数値が大きいほど強い所見を表します。
なぜ今この研究が必要なのですか？
As the number of total knee arthroplasty procedures being performed continues to increase, so too are the number of revision surgeries. Typically, a femoral nerve block is used for postoperative pain management after total knee arthroplasty, but it has been associated with weakness in the quadriceps muscle. Instead, an adductor canal block is a sensory nerve block which allows for the preservation of quadriceps muscle strength and mobilization ability. To the authors’ knowledge, no studies regarding postoperative pain management after revision total knee arthroplasty have been done, necessitating this trial comparing the efficacy of adductor canal block and placebo.
主な研究課題は何ですか？
In patients undergoing revision total knee arthroplasty, does an adductor canal block reduce postoperative pain when compared with placebo?
重要な知見は？
- VAS pain score during flexion of the knee at 4 hours postoperatively was significantly higher in the placebo group than the adductor canal block group (71 +/- 25 mm vs. 52 +/- 22 mm, respectively; p=0.04).
- There were no between group differences in cumulative morphine consumption from 0-25 h (p=0.48), 0-8 h (p=0.97) and 8-24 h (p=0.95).
- Both groups experienced a similar number of vomiting episodes, ondansetron consumption, and degree of nausea and sedation at all follow-ups.
最も覚えておくべきことは？
Adductor canal block significantly reduced VAS pain score at 4 hours postoperatively compared with placebo. Cumulative morphine consumption and adverse events were similar between groups.
それが私の患者ケアにどのように影響するか？
Based on the findings of this trial, adductor canal block was able to provide adequate pain relief after revision total knee arthroplasty, but between group differences only occurred at 4 hours postoperatively. Due to a large number of dropouts, the results from this study are underpowered and should be interpreted with caution. Future studies will need to assess a larger sample size before adductor canal block can be recommended.
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