Objective To assess the efficacy and safety of nerve-stimulator-guide needle placement in the peripheral nerve blockade. Methods The Cochrane Library, MEDLINE, OVID, VIP, CNKI and CBM were searched. The quality of the included studies was evaluated by three reviewers, and meta-analysis was performed. Results Twenty studies involving 1 287 participants related to needle placement in the peripheral nerve blockade were included. There were only 2 studies that described a detailed randomization method and allocation concealment and blinding, and the others were inadequate. Meta-analysis based on the included studies showed that: ① Absolute success ratio: nerve-stimulator-guide was higher than eliciting paraesthesia (OR= 4.05, 95%CI 2.57 to 6.36, Plt;0.00001) and anatomy localization (OR=30.3, 95%CI 1.73 to 532.74, P=0.02), but lower than ultrasound-guide-localization (OR=0.27, 95%CI 0.10 to 0.74, P=0.01). ② Onset time of the block: nerve-stimulator-guide was similar to eliciting paraesthesia (WMD= –1.70, 95%CI –?4.50 to 0.95, P=0.08), faster than arteriopalmus localization (WMD= 8.38, 95%CI 0.72 to 16.04, Plt;0.000 01), but slower than ultrasound-guide-localization (WMD= 8.38, 95%CI 0.72 to 16.04, P=0.04). ③ Ratio of complication associated to block: nerve-stimulator-guide was similar to eliciting paraesthesia (OR= 1.01, 95%CI 0.55 to 1.86, P=0.97), anatomy localization (WMD= 0.06, 95%CI 0.00 to 1.21, P=0.07) and arteriopalmus localization (WMD= 8.82, 95%CI 0.10 to 4.11, P=0.65), but higher than ultrasound-guide-localization (OR= 5.03, 95%CI 1.74 to 14.49, P=0.003). ④ Time to block: nerve-stimulator-guide was similar to eliciting paraesthesia (WMD=0.02, 95%CI –0.46 to 0.51, P=0.92), shorter than arteriopalmus localization (WMD= –4.00, 95%CI –5.58 to –2.42, Plt;0.000 01) and longer than ultrasound-guide-localization (WMD= 1.90, 95%CI 0.47 to 3.33, P=0.009). ⑤ Patient-accepted ratio: nerve-stimulator-guide was higher than eliciting paraesthesia (OR=2.32, 95%CI 1.02 to 5.30, P=0.05), and similar to arteriopalmus localization (OR=8.14, 95%CI 0.88 to 75.48, P=0.06). Conclusion Nerve-stimulator-guide location is a precise, effective and safe localization method. Due to moderate risk of selection bias and detection bias of included studies, the evidence is not b. Our results suggest that well-designed double-blind randomized controlled and larger-scale trials on the use of nerve stimulator in the peripheral nerve block are needed.
Objective To compare the anesthetic effects of traditional digital block with single-injection digital block in digital injury patients for subcutaneous digital blocks. Methods Patients with one or two digits injured were randomized to the traditional digital block group and single-injection digital block group. All of the blocks were conducted by one investigator. The patients and outcome assessor were blinded to the treatment allocation. Both of the per-protocol-population (PP) analysis and the intention-to-treatment (ITT) analysis were performed to compare the two block techniques in terms of the pain during infiltration, the onset time of anesthesia and the failure rate of anesthesia. Results A total of 93 patients (109 digits) were included with 51 (61 digits) in the traditional block group and 42 (48 digits) in the single-injection block group.Two patients (3 digits) dropped out. Both of the PP analysis and ITT analysis showed that no significant difference between the two groups were detected in terms of the pain during infiltration, the onset time of anesthesia and the failure rate of anesthesia (P﹥0.05). Conclusions The subcutaneous single-injection digital block is as effective as the traditional digital block, but is much easier to perform. This technique is indicated for the digital anesthesia of palmar aspect distal to the proximal digital crease and dorsal aspect of the distal and middle phalanxes.
ObjectiveTo compare postoperative analgesic efficacy and motor function recovery between ultrasound guided adductor canal block (ACB) and Femoral nerve block (FNB) in patients after total knee arthroplasty (TKA). MethodsFrom March to April 2014, 40 patients chosen to receive TKA under general anesthesia were randomly allocated to FNB group and ACB group with 20 in each group. Opioids consumption during and after operation, pain score in rest and movement, the force of quadriceps femoris, activity of knee and complications after surgery were recorded. ResultsNo differences were found in opioids consumption during and after operation, pain score in rest and movement after operation. Patients of ACB group were superior to those of FNB group in motor function recovery. At hour 2, 4, 8, 12, 24, and 48 after operation, the force of quadriceps femoris was higher in patients of ACB group than those of FNB group (P<0.05). Activity of knee was higher in patients of ACB group than those of FNB group postoperatively. ConclusionACB and FNB have equal postoperative analgesic effect for TKA patients. But ACB has less influence on the force of quadriceps femoris than FNB. Therefore, patients of ACB group are superior to those of FNB group in motor function recovery, showing better activity of knee and early time of first straight leg raising.
ObjectiveTo investigate the effect and safety of subgluteal approach continous sciatic nerve block with 0.2% ropivacaine for postoperative analgesia in calcaneal fracture patients. MethodsForty calcaneal fracture patients treated from May 2012 to January 2013 were randomly assigned to two groups:20 patients in continuous sciatic nerve block group (group CSB) and 20 patients in self-controlled intravenous analgesia group (group PCIA).Patients in group CSB were given subgluteal approach continuous sciatic nerve block,and PCA pump was connected to give 0.2% ropivacaine via continuous nerve block catheter continuously for analgesia.Patients in group PCIA were given PCA pump directly for self-controlled intravenous analgesia.The movement/rest VAS scores and Ramsay scores at 2,8,24,48 hours after surgery,the dose of other analgesia drugs after surgery,the satisfaction of patients and surgeons,and side effects were recorded. ResultsThe movement and rest visual analogue scale (VSA) scores and the dose of analgesia drugs in group CSB were significantly lower than group PCIA at all time points (P<0.05).The satisfaction of patients and surgeons in group CSB was higher than group PCIA (P<0.05). ConclusionCompared with self-controlled intravenous analgesia,subgluteal approach continuous sciatic nerve block with 0.2% ropivacaine can provide better and safer postoperative analgesia for calcaneal fracture patients.
ObjectiveTo study the analgesia and rehabilitation effect of femoral nerve block after anterior cruciate ligament reconstruction (ACLR). MethodsDuring June to September 2014, 62 patients who were scheduled to undergo ACLR were randomly divided into two groups:femoral nerve block group (n=31) and control group (n=31). All the patients were given celecoxib 200 mg (twice per day) three days before surgery. Patients in the femoral nerve block group were given a single-injection femoral nerve block (SFNB) half an hour before surgery (ropivacaine 0.75%, 30 mL), Both of the two groups underwent ice therapy after surgery. The visual analogue scale (VAS) scores, knee joint range of motion, the muscle strength of quadriceps femoris, the side effects, complications and infection rate were recorded after the operation. ResultsThe VAS scores were significantly lower in the femoral nerve block group within 2 hours to 7 days after surgery (P<0.05), and the use of morphine was less than the control group in all the time points with statistical significance (P<0.05). The muscle strength of quadriceps femoris was significantly weaker in the femoral nerve block group than the control group in the first 12 hours (P<0.05). The side effects and infection rate between the two group had no significant difference (P>0.05). ConclusionThe femoral nerve block in anterior cruciate ligament reconstruction before surgery has a good effect on postoperative analgesia and rehabilitation, which is worth popularizing and applying.
ObjectiveTo investigate the efficacy of sequential treatment with adductor canal nerve block (ACNB) and cyclooxygenase 2 (COX-2) selective inhibitor (parecoxib and celecoxib) after primary total knee arthroplasty (TKA). MethodsBetween January 2015 and December 2015, 90 osteoarthritis patients who met the inclusion criteria were treated, and randomly divided into 3 groups:ACNB+COX-2 group (group A, n=30), COX-2 group (group B, n=30), and control group (group C, n=30). There was no significant difference in gender, age, body mass index, side, and osteoarthritis duration between groups (P > 0.05), and the data were comparable. ACNB was used in group A at the end of TKA. Intravenous injection of parecoxib (40 mg per 12 hours) was administrated at the first three postoperative days, and followed by oral celecoxib (200 mg per 12 hours) until 6 weeks after operation in groups A and B; while placebo was given at the same time point in group C. Oral tramadol or intravenous morphine, as remedial measures, were introduced when patients had a visual analogue scale (VAS) score more than 4. The following indicators were compared between groups:the operative time, drainage volume at 24 hours after operation, length of hospital stay, and incidence of side effect; VAS pain scores, morphine consumption, range of motion (ROM) of the knee joint, and inflammatory cytokines levels at pre-operation and at 1 day, 2 days, 3 days, 1 week, 2 weeks, 4 weeks, and 6 weeks after operation; morphine consumption within first 24 hours and at 24 hours to 6 weeks after operation; the American Hospital for Special Surgery (HSS) score at 1, 2, 4, and 6 weeks after operation; and the serum coagulation parameters at pre-operation, and at 1, 3, and 14 days after operation. ResultsThe length of hospital stay was significantly shorter and the incidence of postoperative nausea and vomiting was significantly lower in groups A and B than group C (P < 0.05). The VAS scores at rest (VASR) of groups A and B were significantly lower than that of group C at 1, 2, and 3 days after operation (P < 0.05); difference in the VAS scores at walking (VASW) was significant between groups at 1 day after operation (P < 0.05), and group A had the lowest VASW; and the VASW of groups A and B were significantly lower than that of group C at 2 and 3 days and at 1, 2, 4, and 6 weeks after operation (P < 0.05). The difference in morphine consumption was significant between groups within the first 24 hours after operation (P < 0.05), and group A exhibited the lowest consumption; and the morphine consumption in groups A and B was significantly lower than that in group C at 24 hours to 6 weeks after operation (P < 0.05). Significant difference was found in HSS scores between groups at 1, 2, 4, and 6 weeks after operation, and group A showed the highest score (P < 0.05). At 1 and 2 days after operation, group A showed the highest ROM (P < 0.05), and ROM of groups A and B was significantly higher that of group C at 3 days, 1 week, 2 weeks, 4 weeks, and 6 weeks after operation (P < 0.05). Groups A and B were significantly lower than group C in the serum erythrocyte sedimentation rate at 2 days, 3 days, 1 week, 2 weeks, 4 weeks, and 6 weeks, in C-reactive protein levels at 1, 2, and 3 days, in interleukin 6 (IL-6) and TNF-α levels at 1 day to 6 weeks, and in IL-8 level at 2 and 3 days (P < 0.05). The drainage volume within the first 24 hours and the serum coagulation parameters within the 2 weeks after operation showed no significant difference between groups (P > 0.05). ConclusionSequential treatment with ACNB and COX-2 selective inhibitor is a safe and effective approach for postoperative pain management after primary TKA, and it can alleviate postoperative pain, promote the joint function recovery, and reduce the risk of adverse reactions.
ObjectiveTo systematically evaluate the analgesic efficacy of local infiltration analgesia versus femoral nerve block for total knee arthroplasty. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 4, 2016), WanFang Data, CBM, and CNKI were searched to collect randomized controlled trials (RCTs) about the analgesic efficacy of local infiltration analgesia versus femoral nerve block for total knee arthroplasty from inception to April 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. The meta-analysis was conducted using RevMan 5.3 software. ResultsA total of 13 RCTs involving 1 001 patients were included. The results of meta-analysis showed that: There were no significant differences in pain scores at rest (SMD=0.02, 95%CI -0.23 to 0.27, P=0.86), morphine consumption on movement (MD=-1.85, 95%CI -4.67 to 0.97, P=0.20), incidence of post-operative nausea and vomiting (RD=0.02, 95%CI -0.03 to 0.08, P=0.41) and incidence of post-operative knee infection (RD=0.01, 95%CI -0.02 to 0.03, P=0.60) between the two groups, but he local infiltration analgesia group had lower length of stay than the femoral nerve block group with statistical difference (SMD=-0.24, 95%CI -0.41 to -0.07, P=0.005). ConclusionLocal infiltration analgesia provides similar postoperative analgesia after total knee arthroplasty to femoral nerve block. However, due to the limited quantity of the included studies, the above conclusion still need to be verified by more high quality studies.
Objective To overview the systematic reviews/meta-analyses of efficacy of FNB used as a postoperative analgesic technique among patients undergoing TKR. Methods We electronically searched databases including The Cochrane Library, PubMed, EMbase, CNKI, WanFang Data and VIP from inception to July, 2016. Two reviewers independently screened literature and extracted data. AMSTAR tool was used to assess the methodological quality of included studies. The primary outcome was pain scores and the consumption of opoid medicine to evaluate the effectiveness of FNB. Results A total of 16 systematic reviews/meta-analyses were included, involving the FNBvs. LIA, PMDI, EA, PCA and ACB, respectively. The results of quality assessment indicated medium scores with 3 to 9 scores. The overviews’ results showed that: at rest, FNB was not superior to LIA at 6h after TKR; it was superior to PMDI at 12h after TKR; it was also superior to PCA and LIA, but not superior to ACB at 24h after TKR. On movement, FNB was superior to PCA and LIA at 24h after TKR; it was also superior to PCA at 48h after TKR. As to the consumption of opoid medicine, the consumption in FNB group was more than LIA group at 12h after TKR. In addition, the consumption in FNB group was less than PCA and LIA at 24h after TKR, and it was also less than PCA and ACB at 48h. The satisfaction of patients who received FNB was better than ACB, EA and PCA. Conclusion The current overview shows that FNB is more effective than PCA and LIA, the patients’ satisfaction is better. Due to the limitations of the quantity and quality of included studies, the above conclusions are needed to be verified by more studies.
Objectives To overview the systematic reviews/meta-analyses of safety of femoral nerve block (FNB) used as a postoperative analgesic technique in patients undergoing total knee arthroplasty (TKA). Methods We searched databases including The Cochrane Library, PubMed, EMbase, CNKI, WanFang Data, and VIP from inception to July, 2016. Two reviewers independently screened literature, extracted data and used AMSTAR to evaluate the methodological quality of the included studies. The major indexes used to evaluate the safety of FNB were the incidence rates of symptoms including nausea, vomiting, sedation, retention of urine, dizziness, pruritus, hypotension, falls, nenous thromboembolism and deep infection. Results A total of 12 systematic reviews/meta-analyses were included.They assessed the safety of FNB compared with local infiltration analgesia (LIA), periarticular multimodal drug injection (PMDI), epidural analgesia (EA), patient-controlled intravenous analgesia of opioids (PCA) and adductor canal block (ACB), respectively. The methodological quality of included studies were medium, with the scores between 3 to 10. The results of overview indicated that: FNB had lower incidence rates of nausea and vomiting compared with EA and PCA, but had higher than ACB. FNB had lower incidence rates of sedation and retention of urine compared with EA and PCA. FNB had lower incidence rates of dizziness compared with EA and PCA, and lower incidence rate of hypotension compared with EA. Conclusion Current evidence suggests that FNB is safer than EA and PCA. Due to the limited quantity and quality of the included studies, the above conclusions are needed to be verified by more high-quality studies.
Objective To compare the analgesia effect and clinical rehabilitation between continuous adductor canal block (ACB) and single shot ACB in total knee arthroplasty (TKA)． Methods Between October 2016 and February 2017, 60 patients with severe knee osteoarthritis undergoing primary unilateral TKA were prospectively recruited in the study. All the patients were randomly allocated into 2 groups and received ultrasound-guided continuous ACB (group A, n=30) or single shot ACB (group B, n=30), respectively. There was no significant difference in gender, age, body mass index, nationality, American Society of Anesthesiology (ASA) grading, and preoperative knee range of motion and quadriceps strength between 2 groups (P>0.05). After operation, the tourniquet time, postoperative drainage volume, hospitalization time, and adverse events in 2 groups were recorded. Visual analogue scale (VAS) scores at rest and during activity, the quadriceps strength, the knee range of motion, and the time of 90° knee flexion in 2 groups were also recorded and compared. Results There was no significant difference in tourniquet time, postoperative drainage volume, and incidence of adverse events between 2 groups (P>0.05). But the hospitalization time was significant shorter in group A than in group B (P<0.05). VAS scores at rest and during activity were lower in group A than in group B, with significant differences in VAS score at rest after 12 hours and in VAS score during activity after 8 hours between 2 groups (P<0.05). The quadriceps strength was higher in group A than in group B, with significant difference at 24, 48, and 72 hours (P<0.05). The knee range of motion was significantly better in group A than in group B at 24, 48, 72 hours and on discharge (P<0.05). The time of 90° knee flexion was significantly shorter in group A than in group B (t=–2.951, P=0.016). There were 4 patients in group A and 7 patients in group B requiring meperidine hydrochloride (50 mg/time) within 24 hours, and 3 patients in group A and 7 patients in group B at 24 to 48 hours, and 1 patient in group A and 3 patients in group B at 48 to 72 hours. Effusion in the catheter site occurred in 2 cases of group A, but no catheter extrusion occurred. Conclusion Continuous ACB is superior in analgesia both at rest and during activity and opioid consumption compared with single shot ACB after TKA. And the quadriceps strength could be reserved better in continuous ACB group, which can perform benefits in early rehabilitation.