超声引导下股神经阻滞用于全膝关节置换术后镇痛的初步观察
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摘要
目的 观察超声引导下股神经阻滞用于全膝关节置换术后镇痛的可行性。方法 选择ASAⅡ级行单侧全膝关节置换患者30例,随机分为2组:股神经阻滞组(FA,n=15)和持续硬膜外镇痛组(EA,n=15)。所有患者均实施腰硬联合阻滞麻醉,FA组患者麻醉前行超声引导下股神经阻滞。FA组、EA组术后分别通过留置导管持续输注0.2%罗哌卡因联合0.5μg/mL舒芬太尼镇痛,两组患者均维持镇痛48h。记录静息、主动和持续被动功能训练时的VAS疼痛评分、开始下床活动时间、镇静程度、肌力分级和并发症发生率。结果 FA组患者在术后6h、24h、48h的静息、主动和持续被动功能训练时的VAS疼痛评分均明显低于EA组患者(P<0.05或P<0.01);两组患者下床活动时间无显著性差异,(34±2)h vs(36±4)h,P>0.05;两组患者镇静程度总体较满意;两组患者的术后24~48h肌力评分平均大于3级;与EA组比较,FA组患者并发症发生例数明显减少,差异具有显著统计学意义(4vs12,P=0.009)。结论 超声引导下股神经阻滞镇痛效果良好,对下肢肌力影响轻微,并发症发生率低,是TKA术后较为理想的康复镇痛方法。
Objective To evaluate the effects of postoperative analgesia by ultrasound-guided continuous femoral nerve block after total knee arthroplasty(TKA). Methods A total of 30 patients of ASA, undergoing TKA were randomized into two groups: continuous femoral nerve block group(FA, n=15), continuous epidural analgesia group(EA, n=15). All the patients had received combined spinalepidural anesthesia. In group FA, the patients received ultrasound-guided continuous femoral nerve block before continuous spinalepidural anesthesia. In group EA, the patients only received continuous combined spinal-epidural anesthesia. The postoperative patientcontrolled analgesia(PCA) for both groups were performed continuously with 0.2% Ropivacaine + 0.5μg/mL sufentanil by indwelling catheter. The postoperative analgesia of the two groups sustained for 48 h. The detection indicators included the visual analogue scale(VAS) of rest pain, active and passive movement of the knee after TKA,the first time for loaded walk, muscle strength and the rate of adverse reactions postoperation. Results In the FA group, the VAS score of rest pain, active and passive movement of the knee in the postoperative of 6 h, 24 h, 48 h were significant lower than that of the EA group(P<0.05 or P<0.01); There was no significant difference between the two groups in the period of first postoperative loaded walk [FA group:(34±2)h and EA group:(36±4)h, P>0.05]. The 24~48 h muscle strength score of the two groups was higher than grade 3. Compared with group EA, the incidence of complications in group FA was significantly reduced, and the difference was statistically significant(4 vs 12, P=0.009). Conclusion Ultrasound-guided continuous femoral nerve block could obtain excellent postoperative analgesia effect and benefit to the knee function recovery after TKA, with less effect on muscle strength of the lower extremity and less adverse reactions.
Objective To evaluate the effects of postoperative analgesia by ultrasound-guided continuous femoral nerve block after total knee arthroplasty(TKA). Methods A total of 30 patients of ASA, undergoing TKA were randomized into two groups: continuous femoral nerve block group(FA, n=15), continuous epidural analgesia group(EA, n=15). All the patients had received combined spinalepidural anesthesia. In group FA, the patients received ultrasound-guided continuous femoral nerve block before continuous spinalepidural anesthesia. In group EA, the patients only received continuous combined spinal-epidural anesthesia. The postoperative patientcontrolled analgesia(PCA) for both groups were performed continuously with 0.2% Ropivacaine + 0.5μg/mL sufentanil by indwelling catheter. The postoperative analgesia of the two groups sustained for 48 h. The detection indicators included the visual analogue scale(VAS) of rest pain, active and passive movement of the knee after TKA,the first time for loaded walk, muscle strength and the rate of adverse reactions postoperation. Results In the FA group, the VAS score of rest pain, active and passive movement of the knee in the postoperative of 6 h, 24 h, 48 h were significant lower than that of the EA group(P<0.05 or P<0.01); There was no significant difference between the two groups in the period of first postoperative loaded walk [FA group:(34±2)h and EA group:(36±4)h, P>0.05]. The 24~48 h muscle strength score of the two groups was higher than grade 3. Compared with group EA, the incidence of complications in group FA was significantly reduced, and the difference was statistically significant(4 vs 12, P=0.009). Conclusion Ultrasound-guided continuous femoral nerve block could obtain excellent postoperative analgesia effect and benefit to the knee function recovery after TKA, with less effect on muscle strength of the lower extremity and less adverse reactions.
引文
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[2]刘晓.成人开腹手术术后静脉自控镇痛芬太尼消耗量的影响因素分析[D].广西医科大学,2013.
[3]Hugh W,Spencer S,Paul D,et al.Peripheralnerve blocks improve analgesia after total knee replacement surgery[J].Anesth Analg,1998,87(1):93-97.
[4]Szczukowski MJ,Hines JA,Snell JA,et al.Femoral nerve block for total knee arthroplasty patients:a method to control postoperative pain[J].J Arthroplasty,2004,19(6):720-725.
[5]Mahoney OM,Noble PC,Davidson J,et al.The effect of continuous epidural analgesia on postoperative pain,rehabilitation,and duration of hospitalization in total knee arthroplasty[J].Clin Orthop Relat Res,1990,260(260):30-37.
[6]Winnie AP,Ramamurthy S,Durrani Z.The inguinal paravascular technic of lumbar plexus anesthesia:the"3-in-1 block"[J].Anesthesia&Analgesia,1973,52(6):989.
[7]庞佳宁,刘劲松,李溪,等.TKA术后连续股神经阻滞早期镇痛疗效[J].昆明医科大学学报,2016,37(11):64-69.
[8]Singelyn FJ,Deyaert M,Joris D,et al.Effects of intravenous patient-controlled analgesia with morphine,continuous epidural analgesia,and continuous threein-one block on postoperative pain and knee rehabilitation after unilateral total knee arthroplasty[J].Anesthesia&Analgesia,1998,87(1):88-92.
[2]刘晓.成人开腹手术术后静脉自控镇痛芬太尼消耗量的影响因素分析[D].广西医科大学,2013.
[3]Hugh W,Spencer S,Paul D,et al.Peripheralnerve blocks improve analgesia after total knee replacement surgery[J].Anesth Analg,1998,87(1):93-97.
[4]Szczukowski MJ,Hines JA,Snell JA,et al.Femoral nerve block for total knee arthroplasty patients:a method to control postoperative pain[J].J Arthroplasty,2004,19(6):720-725.
[5]Mahoney OM,Noble PC,Davidson J,et al.The effect of continuous epidural analgesia on postoperative pain,rehabilitation,and duration of hospitalization in total knee arthroplasty[J].Clin Orthop Relat Res,1990,260(260):30-37.
[6]Winnie AP,Ramamurthy S,Durrani Z.The inguinal paravascular technic of lumbar plexus anesthesia:the"3-in-1 block"[J].Anesthesia&Analgesia,1973,52(6):989.
[7]庞佳宁,刘劲松,李溪,等.TKA术后连续股神经阻滞早期镇痛疗效[J].昆明医科大学学报,2016,37(11):64-69.
[8]Singelyn FJ,Deyaert M,Joris D,et al.Effects of intravenous patient-controlled analgesia with morphine,continuous epidural analgesia,and continuous threein-one block on postoperative pain and knee rehabilitation after unilateral total knee arthroplasty[J].Anesthesia&Analgesia,1998,87(1):88-92.