股神经阻滞与收肌管阻滞在前交叉韧带重建术后镇痛效果的Meta分析

目的 比较股神经阻滞（FNB）与收肌管阻滞（ACB）用于前交叉韧带重建（ACLR）术后镇痛效果。
方法 检索Pubmed、Embase、Web of Science、Cochrane Library、Cochrane Controlled Trials Register、万方、知网、维普数据库，检索时间为建库至2021年3月，收集股神经阻滞（FNB组）与收肌管阻滞（ACB组）用于ACLR术后镇痛效果比较的随机对照试验（RCT），按照Cochrane手册选择文献、提取资料、对纳入文献的方法学质量进行评价，采用RevMan 5.4软件进行Meta分析。
结果 共纳入9篇发表于2014—2021年的RCT研究，共计患者719例，FNB组359例，ACB组360例。FNB组和ACB组术后0～3、6、12、24、48 h疼痛评分差异无统计学意义。FNB组与ACB组术后24、48 h阿片类药物用量、患者满意度差异无统计学意义。5篇文献认为ACB组能更好地保留患者股四头肌肌力，3篇文献认为ACB组与FNB组患者术后股四头肌肌力差异无统计学意义。
结论 ACB与FNB在ACLR术后疼痛评分、阿片类药物用量、患者满意度方面无显著差异，ACB在保留患者股四头肌肌力方面可能更具优势，但还需后续更多研究进一步验证。

Femoral nerve block versus adductor canal block after anterior cruciate ligament reconstruction:

Ojective To compare the analgesic effect of femoral nerve block (FNB) and adductor canal block (ACB) after anterior cruciate ligament reconstruction (ACLR).
Methods PubMed, Embase, Web of science, Cochrane Library, Cochrane Controlled Trials Register, WanFang, CNKI and VIP were searched for randomized controlled trials (RCTs) published from inception to March 2021 comparing FNB and ACB in postoperative analgesia after ACLR. The methodological quality of the included RCTs was assessed and the data were extracted according to the Cochrane Handbook. The Meta-analysis was performed by using RevMan 5.4 software.
Results Nine RCTs published between 2014 and 2021 were included, including 719 patients, 359 in group FNB and 360 in group ACB. There was no significant difference in pain score between groups FNB and ACB 0-3, 6, 12, 24 and 48 hours after ACLR. There was no significant difference in opioid consumption between groups FNB and ACB 24 and 48 hours after ACLR. There was no significant difference in patient satisfaction between groups FNB and ACB at 24 and 48 hours after ACLR. Five researches considered that the muscle strength of quadriceps femoris in group ACB was stronger than that in group FNB, and three researches considered that there was no significant difference between group ACB and group FNB.
Conclusion There is no significant difference between ACB and FNB in postoperative pain score, opioid consumption and patient satisfaction. ACB may have more advantages in preserving quadriceps muscle strength after ACLR, which needs further studies to verify.