连续前路腰丛神经阻滞用于膝关节置换术后镇痛的临床观察
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摘要
目的：观察不同浓度罗哌卡因连续前路腰丛神经阻滞用于全膝关节置换(TKR)术后镇痛的效果。
方法：选择ASAⅠ～Ⅱ级,择期在全身麻醉下行TKR术的患者45例,随机分为3组：静脉持续芬太尼组(A组),0.2%罗哌卡因组(B组)和0.15%罗哌卡因组(C组),每组15例,所有患者均采取静吸复合全身麻醉。A组患者术后持续静脉输注芬太尼镇痛,B组和C组患者分别通过前路腰丛阻滞导管持续输注0.2%罗哌卡因和0.15%罗哌卡因镇痛。3组患者均持续镇痛50 h。记录静息及被动运动时视觉模拟评分(VAS)、肌力分级、镇静程度及副作用发生情况。
结果：B组和C组患者术后8、12、24、48 h静息和运动时VAS评分均明显低于A组,P<0.05或P<0.01,B、C组患者之间差异无统计学意义。3组患者肌力均良好,无统计学差异。A组患者镇静过度、恶心及镇痛不全发生率均较高。
结论：0.15%或0.2%罗哌卡因连续前路腰丛神经阻滞用于全膝关节置换术后镇痛效果良好,对肌力影响小,副作用发生率低。
Objective:To observe the effect of continuous anterior lumbar plexus block with different concentration ropivacaine on postoperative pain relief after total knee prosthesis (TKR).
Methods:Forty-five ASAI-II patients undergoing unilateral TKR under general anesthesia were selected.They were randomly divided into three groups.The patients of group A received continuous intravenous fentanyl,. The patients of group B were given 0.2%ropivacaine through a nerve block catheter, and the patients of group C were given 0.15%ropivacaine through the same catheter. All patients were maintained analgesia for 50 hours. Visual analogue score (VAS) during rest and movement, muscle strength grades, sedation level and complications were recorded.
Results:The VAS during rest and movement at postoperative 4 h,8 h,12 h,24 h,48 h of group B and C were all obvious lower than those in group A, P<0.05 or P<0.01. There weren't significant difference about the VAS between group B and group C Compared with group A, the incidence of side effects was significant lower in group B and C. It was satisfactory about average muscle strength degree in all groups.
Conclusion:After TKR surgery, modiffied continuous anterior lumbar plexus block with 0.15%or 0.2%ropivacaine can provide adequate pain relief, slight impact on muscle strength and fewer side effects.
方法：选择ASAⅠ～Ⅱ级,择期在全身麻醉下行TKR术的患者45例,随机分为3组：静脉持续芬太尼组(A组),0.2%罗哌卡因组(B组)和0.15%罗哌卡因组(C组),每组15例,所有患者均采取静吸复合全身麻醉。A组患者术后持续静脉输注芬太尼镇痛,B组和C组患者分别通过前路腰丛阻滞导管持续输注0.2%罗哌卡因和0.15%罗哌卡因镇痛。3组患者均持续镇痛50 h。记录静息及被动运动时视觉模拟评分(VAS)、肌力分级、镇静程度及副作用发生情况。
结果：B组和C组患者术后8、12、24、48 h静息和运动时VAS评分均明显低于A组,P<0.05或P<0.01,B、C组患者之间差异无统计学意义。3组患者肌力均良好,无统计学差异。A组患者镇静过度、恶心及镇痛不全发生率均较高。
结论：0.15%或0.2%罗哌卡因连续前路腰丛神经阻滞用于全膝关节置换术后镇痛效果良好,对肌力影响小,副作用发生率低。
Objective:To observe the effect of continuous anterior lumbar plexus block with different concentration ropivacaine on postoperative pain relief after total knee prosthesis (TKR).
Methods:Forty-five ASAI-II patients undergoing unilateral TKR under general anesthesia were selected.They were randomly divided into three groups.The patients of group A received continuous intravenous fentanyl,. The patients of group B were given 0.2%ropivacaine through a nerve block catheter, and the patients of group C were given 0.15%ropivacaine through the same catheter. All patients were maintained analgesia for 50 hours. Visual analogue score (VAS) during rest and movement, muscle strength grades, sedation level and complications were recorded.
Results:The VAS during rest and movement at postoperative 4 h,8 h,12 h,24 h,48 h of group B and C were all obvious lower than those in group A, P<0.05 or P<0.01. There weren't significant difference about the VAS between group B and group C Compared with group A, the incidence of side effects was significant lower in group B and C. It was satisfactory about average muscle strength degree in all groups.
Conclusion:After TKR surgery, modiffied continuous anterior lumbar plexus block with 0.15%or 0.2%ropivacaine can provide adequate pain relief, slight impact on muscle strength and fewer side effects.
引文
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[1]Salinas FV, Liu SS, Mulroy MF. The effect of single injection femoral nerve block versus continuous femoral nerve block after total knee arthroplasty on hospital length of stay and long-term functional recovery within an established clinical pathway[J]. Anesth Analg,2006,102 (4):1234
[2]Bourne MH. Analgesics for orthopedic postoperative pain[J]. Am J Orthop, 2004,33(3):128-135
[3]Skinner HB, Shintani EY. Results of a multimodal analgesic trial involving patients with total hip or total knee arthroplasty[J]. Am J Orthop,2004, 33(2):85-92
[4]Xavier Capdevila, Yves Barthelet. Efects of perioperative analgesic technique on the Surgical outcome and duration of rehabilitation after major knee surgery[J]. Anesthesiology.1999,91(4):8-15
[5]Wang H, Boctor B, Verner J. The effect of single-injection femoral nerve block on rehabilitation and length of hospital stay after total knee replacement[J].Reg Anesth Pain Med,2002,27(2):139-144
[6]Choi PT, Bhandari M, Scott J.Epidural analgesia for pain relief following hip or knee replacement[J].Cochrane Database Syst Rev,2003,(3) CD003071
[7]Farag E, Dilger J, Brooks P. Epidural analgesia improves early rehabilitation after total knee replacement J] J Clin Anesth,2005,17(4):281-285
[8]AxelssonK, Johanzon E, EssvingP. Postoperative extradural analgesia with morphine and ropivacaine 10mg/h or 16mg/h[J].Acta Anaesthesiol Scand, 2005,49(8):1191-1199
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[10]庄心良,曾因明,陈伯銮.现代麻醉学[M].北京：人民卫生出社,2004：1064
[11]Raimer C, Priem K, Wiese AA. Continuous psoas and sciatic block after knee arthroplasty:good effects compared to epidural analgesia or I.V. opioid analgesia:a prospective study of 63 patients[J]. Acta Orthop,2007,78(2):193-200.
[12]Siddiqui ZI, Cepeda S, Denman W. Continuous lumbar plexus block provides improved analgesia with fewer side effects compared with systemic opioids after hip arthroplasty:a randomized controlled trial [J]. Reg Anesth Pain,2007,32(5):393-398.
[13]Allen HW, Liu SS, Ware PD.Peripheral nerve blocks improve analgesia after total knee replacement surgery[J].Anesth Analg,1998,87(1):93-97
[14]Mcnamee DA,Parks L,Milligan KR.Post-operative analgesia following total knee replacement:an evaluation of the addition of an obturator nerve block to combined femoral and sciatic nerve block[J].Acta Anaesthesiol Scand,2002,46(1):95-99
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[16]Kaloul I, Guay J,Cote C.The posterior lumbar plexus (psoas compartment) block and the three-in-one femoral nerve block provide similar postoperative analgesia after total knee replacement J].Can J Anaesth,2004,51 (1):45-51
[17]Ilitzd B M, GearenP F, Enneking F K. Total hip arthroplasty as an overnight-stay procedure using an mnbulatory continuous psoas compartment nerve block:a prospective feasibility study[J]. Reg Anesth Pain Med, 2006,31(2):113-118
[18]Scott DA, Chamley DM, Mooney PH. Epidural ropivacaine infusion for postoperative analgesiaafter mafor lower abdominal surgery—a dose finding study[J]. Anesth Analg,1995,81 (5):982
[19]姜陆洋,李彦平,李树人.连续腰大肌间沟阻滞用于全膝关节置换术后镇痛的临床观察[J].中国疼痛医学杂志,2002,8(3)：149
[20]林惠华,王琼,孙晓雄.后路腰丛阻滞后出现硬膜外阻滞4例报告[J].临床麻醉学杂志,2004,20(4)：225
[21]Winnie AP, Ramamurthy S, Durrani Z. The inguinal paravascular technic of lumbar plexus anesthesia:the"3 in 1"block[J]. Anesth Analg,1973,52(6):989- 996.
[22]贾东林,李水清,南兴东.罗哌卡因或利多卡因持续股神经阻滞用于膝关节置换术后患者康复镇痛的临床研究.中国疼痛医学杂志[J]2008,14(4)：214-217
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[4]Xavier Capdevila, Yves Barthelet. Efects of perioperative analgesic technique on the Surgical outcome and duration of rehabilitation after major knee surgery[J]. Anesthesiology.1999,91(4):8-15
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[8]AxelssonK, Johanzon E, EssvingP. Postoperative extradural analgesia with morphine and ropivacaine 10mg/h or 16mg/h[J].Acta Anaesthesiol Scand, 2005,49(8):1191-1199
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