AbstractThis trial examined the effectiveness of the popliteal plexus block (PPB) and tibial nerve block (TNB) for early rehabilitation after total knee arthroplasty (TKA). We allocated 136 participants to receive PPB or TNB with 0.25% levobupivacaine 10 mL in a randomized, double-masked manner. The primary outcome was achieving rehabilitation goals with a non-inferiority 9-hour margin, including adequate pain relief, knee flexion angles over 90 degrees, and enabling ambulatory rehabilitation.

摘要本试验研究了腘神经丛阻滞（PPB）和胫神经阻滞（TNB）对全膝关节置换术（TKA）后早期康复的有效性。我们分配了136名参与者以随机，双盲的方式接受含0.25%左旋布比卡因10 mL的PPB或TNB。主要结果是实现非劣效性9小时边缘的康复目标，包括充分缓解疼痛，膝关节屈曲角度超过90度，并实现门诊康复。

The time to reach rehabilitation goals showed non-inferiority with 49.7 ± 10.5 h for TNB and 47.4 ± 9.7 h for PPB, whose mean difference (PPB - TNB) was − 2.3 h (95% CI -5.8 to 1.2 h; P < 0.001). PPB showed higher dorsal and plantar percentage of maximum voluntary isometric contraction (dorsal, PPB 87.7% ± 11.4% vs.

达到康复目标的时间显示非劣效性，TNB为49.7±10.5小时，PPB为47.4±9.7小时，其平均差异（PPB-TNB）为-2.3小时（95%CI-5.8至1.2小时；P<0.001）。PPB显示最大自主等长收缩的背侧和足底百分比较高（背侧，PPB 87.7%±11.4%vs。

TNB 74.0% ± 16.5%: P < 0.001; plantar, PPB 90.9% ± 10.3% vs. TNB 72.1% ± 16.0%; P < 0.001) at six hours after nerve block. No significant differences between the two groups emerged in pain scores, knee range of motion, additional analgesic requirements, success in the straight leg raise, and adverse events.

TNB 74.0%±16.5%：P<0.001；足底，PPB为90.9%±10.3%，TNB为72.1%±16.0%；神经阻滞后6小时，P<0.001）。两组之间在疼痛评分，膝关节活动范围，额外的镇痛要求，直腿抬高成功率和不良事件方面没有显着差异。

PPB exhibited non-inferiority to TNB in achieving postoperative rehabilitation goals and had superiority in preserving foot motor strength after TKA. (200).

PPB在实现术后康复目标方面不劣于TNB，并且在TKA后保留足部运动强度方面具有优势。（200）。

Total knee arthroplasty (TKA) is a surgical procedure that effectively alleviates pain and enhances mobility for individuals suffering from knee joint disorders. It is widely known that a combination of regional anesthesia, including peripheral nerve blocks (PNB), and multimodal analgesic techniques is effective in obtaining postoperative analgesia for TKA1.

全膝关节置换术（TKA）是一种外科手术，可有效缓解膝关节疾病患者的疼痛并增强其活动能力。众所周知，包括周围神经阻滞（PNB）在内的区域麻醉和多模式镇痛技术的组合可有效获得TKA1的术后镇痛。

Periarticular injection (PAI) and selective tibial nerve block have been reported to be useful in obtaining postoperative analgesia in the posterior knee joint while preserving ankle joint motion2. In addition, the interspace between the popliteal artery and the posterior capsule of the knee block (IPACK) has also been shown to provide good quality analgesia when combined with adductor canal block (ACB) or femoral triangular block (FTB) while preserving lower leg motor function3.Although previous studies have shown that TNB was less likely to cause the common peroneal nerve block than SNB4, thus preserving postoperative dorsal foot motion, it is worth noting that TNB may affect ankle mobility, depending on the extent of local anesthetic spread5.

据报道，关节周围注射（PAI）和选择性胫神经阻滞可用于在保留踝关节运动的同时获得膝后关节术后镇痛2。此外，当与内收肌管阻滞（ACB）或股三角阻滞（FTB）联合使用时，腘动脉和膝关节后囊阻滞（IPACK）之间的间隙也被证明可以提供高质量的镇痛，同时保留小腿运动功能3。尽管先前的研究表明，TNB比SNB4更不可能引起腓总神经阻滞，从而保留术后足背运动，但值得注意的是，TNB可能会影响踝关节活动性，这取决于局部麻醉剂扩散的程度5。

Additionally, a case report observed IPACK causing spread to the terminal branch of the sciatic nerve, leading to a motor deficiency of dorsal foot motion known as “foot drop”6.Popliteal plexus block (PPB) is a procedure where local anesthetics are injected into the adductor canal, positioned about 1–2 cm above the adductor hiatus.

此外，一份病例报告观察到IPACK导致扩散到坐骨神经的终末分支，导致足背运动的运动缺陷，称为“脚下垂”6。腘神经丛阻滞（PPB）是一种将局部麻醉剂注射到内收肌管中的手术，位于内收肌裂孔上方约1-2厘米处。

The injected solutions then disperse distally to the adductor hiatus and towards the popliteal fossa. To mitigate the risk of SNB, limiting the volume of local anesthetic to 10–15 mL is recommended, allowing for the blockage of the genicular nerve, posterior obturator, and tibial nerves7,8,9. Recent research showed that PPB with FTB resulted in a .

然后注射的溶液向远端扩散到内收肌裂孔和腘窝。。最近的研究表明，PPB与FTB会导致a。

Data availability

数据可用性

The datasets generated and analyzed during the current study are available from the corresponding author upon reasonable request. In addition, sequence data that support the findings of this study have been deposited in the University Hospital Medical Information Network Clinical Trial Registry (UMIN-CTR) with the primary accession code UMIN000040054.

在当前研究期间生成和分析的数据集可根据合理要求从通讯作者处获得。此外，支持本研究结果的序列数据已保存在大学医院医学信息网络临床试验注册中心（UMIN-CTR），主要登录号为UMIN000040054。

(need UMIN ID)UMIN CTR: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi? recptno=R000045668..

（需要UMIN ID）UMIN中心：https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?接收编号=R000045668。。

AbbreviationsTKA:

缩写TKA：

Total knee arthroplasty

全膝关节置换术

PAI:

PAI（PAI）：

Periarticular injection

关节周围注射

PNB:

PNB编号：

Peripheral nerve block

周围神经阻滞

FNB:

FNB：

Femoral nerve block

股神经阻滞

FTB:

FTB：

Femoral triangle block

股骨三角块

ACB:

ACB：

Adductor canal block

内收肌管阻滞

SNB:

SNB：

Sciatic nerve block

坐骨神经阻滞

TNB:

TNB：

Tibial nerve block

胫神经阻滞

ONB:

ONB：

Obturator nerve block

闭孔神经阻滞

IPACK:

IPACK:

The interspace between the popliteal artery and posterior capsule of the knee block

膝关节阻滞的腘动脉与后囊之间的间隙

PPB:

PPB：

Popliteal plexus block

腘丛阻滞

ROM:

ROM（只读存储器）：

Range of motion

运动范围

CONSORT:

配偶：

Consolidated Standards of Reporting Trials

报告试验的综合标准

UMIN:

铝：

University Hospital Medical Information Network

大学医院医疗信息网

ASA:

美国标准协会：

American Society of Anesthesiologists

美国麻醉医师学会

NRS:

编号：

Numeric Rating Scale for pain

SLR:

单反：

Straight leg raise

直腿抬高

MVIC:

MVIC：

Maximum voluntary isometric contraction

最大自愿等长收缩

%MVIC:

%MVIC：

Percentage of preoperative MVIC

术前MVIC百分比

SD:

标准差：

Standard deviation

标准偏差

CI:

CI公司：

Confidence interval

置信区间

POD:

POD（吊舱）：

Postoperative day

术后一天

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Download referencesAcknowledgementsDr. Tomohiro Michino (Department of Anesthesiology, Daiyukai General Hospital, Ichinomiya, Japan) for his advice and generous contribution to the data analysis and manuscript preparation. Enago, a member of Crimson Interactive Pvt. Ltd.　(http://www.enago.com/), contributed to the proofreading and editing of this manuscript.Funding The authors have no sources of funding to declare for this manuscript from any funding agency in public, commercial, or not-for-profit sectors.Author informationAuthors and AffiliationsDepartment of Anesthesiology and Intensive Care Medicine, Daiyukai General Hospital, 1-9-9, Sakura, Ichinomiya, Aichi, 491–8551, JapanNorihiro Sakai, Tomoko Sudani, Chieko Taruishi, Yuki Uematsu & Motoshi Takada Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, Gifu, JapanTakamasa AdachiAuthorsNorihiro SakaiView author publicationsYou can also search for this author in.

下载referencesAcknowledgementsDr。Tomohiro Michino（日本一宫大御总医院麻醉科）为数据分析和手稿准备提供了建议和慷慨贡献。(http://www.enago.com/)，为该手稿的校对和编辑做出了贡献。资金作者没有资金来源可以从公共，商业或非营利性部门的任何资助机构为本手稿申报。作者信息作者和附属机构大育凯综合医院麻醉学和重症监护医学系，1-9-9，樱花，一宫，爱知，491-8551，日本酒井市，Tomoko Sudani，Chieko Taruishi，Yuki Uematsu＆Motoshi Takada岐阜大学医学研究生院麻醉学和疼痛医学系，日本岐阜，Kamasa AdachiAuthorsNorihiro SakaiView作者出版物您也可以在中搜索这位作者。

PubMed Google ScholarTakamasa AdachiView author publicationsYou can also search for this author in

PubMed Google ScholarTakamasa AdachiView作者出版物您也可以在

PubMed Google ScholarTomoko SudaniView author publicationsYou can also search for this author in

PubMed Google ScholarChieko TaruishiView author publicationsYou can also search for this author in

PubMed Google Scholarcieko TaruishiView作者出版物您也可以在

PubMed Google ScholarYuki UematsuView author publicationsYou can also search for this author in

PubMed Google ScholarYuki UematsuView作者出版物您也可以在

PubMed Google ScholarMotoshi TakadaView author publicationsYou can also search for this author in

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PubMed Google ScholarContributionsAll authors designed the study protocol. N.S., T.A., T.S., C.T., and Y.U. recruited patients and conducted this study. N.S. and T.A. analyzed the data, and C.T., T.S., and Y.U. interpreted the study data. M.T. supervised the entire study process.

PubMed谷歌学术贡献所有作者设计了研究方案。N、 S.，T.A.，T.S.，C.T。和Y.U.招募了患者并进行了这项研究。N、 S.和T.A.分析了数据，C.T.，T.S。和Y.U.解释了研究数据。M、 T.监督了整个研究过程。

N.S. prepared the first draft of the manuscript, and then all authors revised it and approved the final version to be published.Corresponding authorCorrespondence to.

N、 美国准备了手稿的初稿，然后所有作者都对其进行了修订，并批准了最终版本的发布。对应作者对应。

Norihiro Sakai.Ethics declarations

酒井北弘。道德宣言

Ethics approval

道德认可

The Institutional Review Board of Daiyukai General Hospital approved the trial protocol (No. 2019-024, March 4, 2020), and all participating patients provided written informed consent. The study was registered in the National Registry (Study ID: UMIN40054: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000045668, April 4, 2020) before patient recruitment.

戴玉凯综合医院的机构审查委员会批准了试验方案（编号2019-0242020年3月4日），所有参与的患者均提供了书面知情同意书。该研究已在国家注册处注册（研究编号：UMIN40054：https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000045668，2020年4月4日），然后招募患者。

Participants gave informed consent to participate in the study before taking part..

参与者在参加研究之前已获得知情同意。。

Competing interests

相互竞争的利益

The authors declare no competing interests.

作者声明没有利益冲突。

Presentation

演示文稿

The abstract of this trial was presented at the 39th Annual Congress of The European Society of Regional Anaesthesia and Pain Therapy in Thessaloniki, Greece, on June 23, 2022.

这项试验的摘要于2022年6月23日在希腊塞萨洛尼基举行的欧洲区域麻醉和疼痛治疗学会第39届年会上发表。

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Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material.

开放获取本文是根据知识共享署名非商业性NoDerivatives 4.0国际许可证授权的，该许可证允许以任何媒介或格式进行任何非商业性使用，共享，分发和复制，只要您对原始作者和来源给予适当的信任，提供知识共享许可证的链接，并指出您是否修改了许可材料。

You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

根据本许可证，您无权共享源自本文或其部分的改编材料。本文中的图像或其他第三方材料包含在文章的知识共享许可证中，除非该材料的信用额度中另有说明。如果材料未包含在文章的知识共享许可中，并且您的预期用途不受法律法规的许可或超出许可用途，则您需要直接获得版权所有者的许可。

To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/..

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Reprints and permissionsAbout this articleCite this articleSakai, N., Adachi, T., Sudani, T. et al. Popliteal plexus block compared with tibial nerve block on rehabilitation goals following total knee arthroplasty: a randomized non-inferiority trial.

转载和许可本文引用本文Sakai，N.，Adachi，T.，Sudani，T。等人。腘神经丛阻滞与胫神经阻滞在全膝关节置换术后康复目标上的比较：一项随机非劣效性试验。

Sci Rep 14, 23853 (2024). https://doi.org/10.1038/s41598-024-74951-yDownload citationReceived: 02 August 2024Accepted: 30 September 2024Published: 11 October 2024DOI: https://doi.org/10.1038/s41598-024-74951-yShare this articleAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard.

科学报告1423853（2024）。https://doi.org/10.1038/s41598-024-74951-yDownloadhttps://doi.org/10.1038/s41598-024-74951-yShare本文与您共享以下链接的任何人都可以阅读此内容：获取可共享链接对不起，本文目前没有可共享的链接。复制到剪贴板。

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KeywordsTotal knee arthroplastyUltrasound-guidedPeripheral nerve blockLower extremityRehabilitationAcute postoperative pain

关键词人工膝关节置换术超声引导下周围神经阻滞下肢康复术后急性疼痛