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外文期刊>Orthopaedic Journal of Sports Medicine
>Intra-articular Morphine and Ropivacaine Injection Provides Efficacious Analgesia As Compared With Femoral Nerve Block in the First 24 Hours After ACL Reconstruction: Results From a Bone–Patellar Tendon–Bone Graft in an Adolescent Population
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Intra-articular Morphine and Ropivacaine Injection Provides Efficacious Analgesia As Compared With Femoral Nerve Block in the First 24 Hours After ACL Reconstruction: Results From a Bone–Patellar Tendon–Bone Graft in an Adolescent Population
Background: Opioid consumption and patient satisfaction are influenced by a surgeon’s pain-management protocol as well as the use of adjunctive pain mediators. Two commonly utilized adjunctive pain modifiers for anterior cruciate ligament (ACL) reconstruction are femoral nerve blockade and intra-articular injection; however, debate remains regarding the more efficacious methodology. Hypothesis: We hypothesized that intra-articular injection with ropivacaine and morphine would be found to be as efficacious as a femoral nerve block for postoperative pain management in the first 24 hours after bone–patellar tendon–bone (BTB) ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: Charts were retrospectively reviewed for BTB ACL reconstructions performed by a single pediatric orthopaedic surgeon from 2013 to 2019. Overall, 116 patients were identified: 58 received intra-articular injection, and 58 received single-shot femoral nerve block. All patients were admitted for 24 hours. Pain scores were assessed every 4 hours. Morphine milligram equivalents (MMEs) consumed were tabulated for each patient. Results: Opioid use was 24.3 MMEs in patients treated with intra-articular injection versus 28.5 MMEs in those with peripheral block ( P = .108). Consumption of MMEs was greater in the intra-articular group in the 0- to 4-hour period (7.1 vs 4.6 MMEs; P = .008). There was significantly less MME consumption in patients receiving intra-articular injection versus peripheral block at 16 to 20 hours (3.2 vs 5.6 MMEs; P = .01) and 20 to 24 hours (3.8 vs 6.5 MMEs; P & .001). Mean pain scores were not significantly different over the 24-hour period (peripheral block, 2.7; intra-articular injection, 3.0; P = .19). Conclusion: Within the limitations of this study, we could identify no significant difference in MME consumption between the single-shot femoral nerve block group and intra-articular injection group in the first 24 hours postoperatively. While peripheral block is associated with lower opioid consumption in the first 4 hours after surgery, patients receiving intra-articular block require fewer opioids 16 to 24 hours postoperatively. Given these findings, we propose that intra-articular injection is a viable alternative for analgesia in adolescent patients undergoing BTB ACL reconstruction.
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机译：背景：阿片类药物消费和患者满意受外科医生的疼痛管理方案以及辅助疼痛调解器的影响。两种常用的辅助止痛剂用于前十字韧带（ACL）重建是股骨神经阻滞和关节内注射;但是，辩论仍然有关更有效的方法。假设：我们假设与Ropivacaine和吗啡的关节内注射术中的内注射液在骨髌骨肌腱（BTB）ACL重建后的前24小时内为术后疼痛管理是术后疼痛管理的有效性。研究设计：队列研究;证据级别，3.方法：回顾性审查2013年至2013年的单个小儿矫形外科医生的BTB ACL重建的图表。总体而言，鉴定了116名患者：58患者接受关节内注射，58名接受单次股骨神经堵塞。所有患者均已入备24小时。每4小时评估疼痛评分。为每位患者制表所消耗的吗啡毫克当量（MMES）。结果：ApioID使用是在患有外围块的关节内注射的患者治疗的患者中使用24.3毫米（P = .108）。在0至4小时内的关节内组中，MME的消耗更大（7.1 Vs 4.6 mmes; p = .008）。在16至20小时接受关节内注射的患者的MME消费显着较低（3.2 Vs 5.6 mmes; p = .01）和20至24小时（3.8 Vs 6.5 mmes; p＆ .001）。在24小时内（外周块，2.7;关节内注射，3.0; p = .19），平均疼痛评分没有显着差异结论：在本研究的局限内，我们可以在术后前24小时内识别单次股骨穴神经块组和关节内注射组之间的MME消耗没有显着差异。虽然外围块在手术后的前4小时内与较低的阿片类药物消耗相关，但接受关节内块的患者术后需要更少的阿片类药物。鉴于这些发现，我们提出了关节内注射是在接受BTB ACL重建的青少年患者中镇痛的可行替代品。
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