Motor-sparing peripatellar plexus block provides noninferior block duration and complete block area of the peripatellar region compared with femoral nerve block: a randomized, controlled, noninferiority study

BMC Anesthesiology

卷:22

Research

Chen-Guang Li¹  Jing-Yu Zhang²  Kun Fan³  Wen-Yi Gong⁴  Xiao-Fang Yue⁵  Jie Min⁶  Xiao-Hui Liao⁶  Cheng Zhu⁶ 

[1] Department of Anaesthesiology, First People’s Hospital of Tianshui, Gansu, China;

[2] Department of Anaesthesiology, Second Hospital Affiliated to Lanzhou University, Gansu, China;

[3] Department of Anaesthesiology, Shanghai Sixth People’s Hospital, No. 600, Yishan Road, 200233, Shanghai, China;

[4] Department of Anaesthesiology, Wusong Central Hospital, Shanghai, China;

[5] Department of Neurology, Shanghai Sixth People’s Hospital, No. 600, Yishan Road, 200233, Shanghai, China;

[6] Department of Orthopaedics, Wusong Central Hospital, Shanghai, China;

关键词: Peripatellar plexus;    Femoral nerve;    Knee surgery;    Nerve block;    Ultrasound;   

DOI  :  10.1186/s12871-022-01863-7

 received in 2022-06-02, accepted in 2022-10-10,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundDeveloping adequate regional anaesthesia for knee surgeries without affecting lower limb mobilization is crucial to perioperative analgesia. However, reports in this regard are limited. We proposed a technique for ultrasound-guided peripatellar plexus (PP) block. Compared with the femoral nerve (FN) block, we hypothesized that this technique would provide a noninferior block duration and a complete cutaneous sensory block in the peripatellar region without affecting lower limb mobilization. An investigation was conducted to verify our hypothesis in cadavers and volunteers.MethodsThe study was designed in two parts. First, eight cadaveric lower limbs were dissected to verify the feasibility of PP block after methylene blue injection under ultrasound. Second, using a noninferiority study design, 50 healthy volunteers were randomized to receive either a PP block (PP group) or an FN block (FN group). The primary outcome was the duration of peripatellar cutaneous sensory block, with the prespecified noninferiority margin of -3.08 h; the secondary outcome was the area of peripatellar cutaneous sensory block; in addition, the number of complete anaesthesias of the incision line for total knee arthroplasty and the Bromage score 30 min after block were recorded.ResultsThe PP was successfully dyed, whereas the FN and saphenous nerve were unstained in all cadaveric limbs. The mean difference of the block duration between the two groups was − 1.24 (95% CI, -2.81 − 0.33) h, and the lower boundary of the two-sided 95% CI was higher than the prespecified noninferiority margin (Pnoninferiority = 0.023), confirming the noninferiority of our technique over FN block. The cutaneous sensory loss covered the entire peripatellar region in the PP group. PP block achieved complete anaesthesia of the incision line used for total knee arthroplasty and a Bromage score of 0 in 25 volunteers, which differed significantly from that of volunteers who underwent FN block.ConclusionUltrasound-guided PP block is a feasible technique. Compared with FN block, PP block provides noninferior block duration and complete blocking of the peripatellar region without affecting lower limb mobilization.Trial registrationThis study was registered in the Chinese Clinical Trial Register (registration no. ChiCTR2000041547, registration date 28/12/2020).

【 授权许可】

CC BY   
© The Author(s) 2022

【 图 表 】

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