随机对照试验比较连续收肌管阻滞联合前路坐骨神经阻滞或局部 浸润对全膝关节置换术后的镇痛效果
| 作者: |
1,2郭小雨,
2王春光,
2丁彦玲
1 承德医学院，河北 承德 067000 2 保定市第一中心医院麻醉科，河北 保定 071000 |
| 通讯: |
丁彦玲
Email: mzdingyanling@sina.com |
| DOI: | 10.3978/j.issn.2095-6959.2018.09.014 |
摘要
目的：探讨超声引导下连续收肌管阻滞联合前路坐骨神经阻滞用于全膝关节置换患者术后的镇痛效果和不良反应。方法：择期全麻下初次行单侧全膝关节置换术(total knee ar throplast y，TKA)患者80例，美国麻醉医师协会(American Society of Anesthesiologists，ASA)分级I~II级，年龄55~ 75岁，体重50~85 kg，性别不限，采用随机数字表法分为连续收肌管阻滞联合前路坐骨神经阻滞组(A组)和连续收肌管阻滞联合局部浸润组(B组)，每组各40例。A组于全身麻醉诱导前行连续收肌管阻滞及前路坐骨神经阻滞，B组于全身麻醉诱导前行连续收肌管阻滞，置入假体时实施膝关节局部浸润。记录离室时、术后3，6，24，48及72 h静态和动态视觉模拟评分法(Visual Analogue Scale，VAS)评分，术后24，48，72 h及1周膝关节活动度和股四头肌肌力及48 h不良反应发生情况。结果：术后3，6，24，72 h时，A组静息痛VAS评分小于B组，差异有统计学意义(P<0.05)；术后3，6，24 h运动痛VAS评分小于B组，差异有统计学意义(P<0.05)。术后48 h膝关节活动度A组大于B组，差异有统计学意义(P<0.05)，两组术后24，72 h及术后1周膝关节活动度差异无统计学意义(P>0.05)。A组有7例出现呕吐，B组有15例出现呕吐，差异有统计学意义(P<0.05)。结论：连续收肌管阻滞联合前路坐骨神经阻滞对TKA患者术后镇痛效果显著，术后并发症少，有利于患者早期功能锻炼和康复。
关键词：
收肌管；坐骨神经；神经阻滞；镇痛；全膝关节置换术
Continuous adductor canal block combined with anterior sciatic nerve block versus continuous adductor canal block combined with local infiltration analgesia for pain relief after total knee arthroplasty: A randomized controlled trial
CorrespondingAuthor: DING Yanling Email: mzdingyanling@sina.com
DOI: 10.3978/j.issn.2095-6959.2018.09.014
Abstract
Objective: To investigate the effects of ultrasound-guided continuous adductor canal block (CACB) combined with anterior sciatic nerve block (SNB) versus CACB combined with local infiltration anesthesia (LIA) for postoperative analgesia in the patients undergoing total knee arthroplasty. Methods: Eighty patients with elective unilateral total knee arthroplasty, aged 55–75 years, weighed 50–85 kg, American Society Anesthesiologists physical status I–II, were divided into group A (CACB combined with SNB group) and group B (CACB combined with LIA group), 40 patients in each group. Ultrasound adductor canal block and sciatic nerve block were performed with 0.5% ropivacaine 20 mL before induction in group A. Ultrasound adductor canal block were performed with 0.5% ropivacaine 20 mL before induction and after installation of the knee prosthesis, local infiltration anesthesia was conducted with 0.2% ropivacaine 50 mL around the knee joint. At 0, 3, 6, 24, 48, 72 h after surgery, Visual Analogue Scale (VAS) score at rest and during activity were recorded, at 24, 48, 72 h, 1 week after surgery the quadriceps strength and active range of knee flexion was measured. The requirement for analgesic drugs and development of adverse reactions was recorded. Results: At 3, 6, 24 and 72 h after the surgery, there were significant differences (P<0.05) on the VAS score at rest between the two groups. The VAS scores during activity decreased significantly at 3, 6, and 24 h after surgery (P<0.05). The knee joint mobility at 48 h after operation in group A was greater than that in group B (P<0.05). There was significant difference between the two groups in postoperative 72-hour quadriceps strength (P<0.05), and there was no significant difference in the quadriceps strength in the rest of the period (P>0.05). Seven patients in group A had vomiting, and 15 patients in group B had vomiting. The difference was significant (P<0.05). Conclusion: Continuous adductor canal block combined with anterior sciatic nerve block is beneficial for early functional rehabilitation, which has a significant effect on postoperative analgesia in patients with total knee arthroplasty, and has fewer postoperative complications.
Keywords：
adductor canal; sciatic nerve; nerve block; analgesia; total knee arthroplasty