超声引导隐神经阻滞对膝关节置换术后镇痛效果观察

Effect of ultrasound-guided saphenous nerve block on analgesia after knee joint replacement

目的实施膝关节置换治疗患者术后疼痛十分明显,给患者造成精神与生理多方面压力,进而影响患者术后恢复和功能锻炼,甚至引发并发症导致手术失败。本研究探讨超声引导下隐神经阻滞在膝关节置换术后镇痛中应用价值。方法选择2018-01-01—2019-04-30大连医科大学附属大连市中心医院收治的老年膝骨性关节炎实施膝关节置换术患者80例,按照性别、年龄、病程和病变部位组间均衡的原则分为两组,各40例。对照组使用连续硬膜外镇痛,观察组使用超声引导下隐神经阻滞,比较术后2h两组比目鱼肌H反射波幅及潜伏期变化,统计两组术后不同时间点疼痛数字评分(numerical rating scale,NRS)评分及围麻醉期两组并发症。结果观察组比目鱼肌H反射波幅为(3.60±0.15)mV,大于对照组的(1.66±0.14)mV,t=59.799,P<0.001;潜伏期为(25.3±0.21)ms,小于对照组的(29.1±0.33)ms,t=61.442,P<0.001。观察组术后6h NRS评分为(2.3±0.2)分,低于对照组的(4.3±0.7)分,t=17.375,P<0.001;术后24h NRS评分为(2.4±0.2)分,低于对照组的(4.1±0.6)分,t=17.000,P<0.001;术后48h NRS评分为(2.1±0.3)分,低于对照组的(3.6±0.5)分,t=16.270,P<0.001。观察组术后并发症发生率为7.5%,低于对照组的30%,χ~2=5.251,P=0.022。结论针对膝关节置换术,实施超声引导下隐神经阻滞,对术后下肢运动功能影响小,能有效控制疼痛,安全性高。

OBJECTIVE Postoperative pain of patients undergoing knee arthroplasty is very obvious,which causes mental and physiological pressure on patients,and then affects the recovery and functional exercise of patients,and even causes complications leading to the failure of surgery.This study aims to investigate the value of ultrasound-guided saphenous nerve block in analgesia after knee arthroplasty.METHODS Totally eighty elderly patients with knee osteoarthritis who underwent knee arthroplasty in Dalian Central Hospital Affiliated to Dalian Medical University from January 01,2018 to April 30,2019 were selected.They were divided into two groups according to the principle of gender,age,course of disease and the balance of lesion sites,40 cases in each group.The control group was given continuous epidural analgesia,while the observation group was given ultrasound-guided saphenous nerve block.The changes of H-reflex amplitude and latency of soleus muscle in two groups were compared 2 hours after operation.The numerical rating scale(NRS)score and complications in two groups at different time points after operation were counted.RESULTS In the observation group,the H-reflection amplitude of the soleus muscle was(3.60±0.15)mV,which was greater than that of the control group(1.66±0.14)mV,t=59.799,P<0.001;the incubation period was(25.3±0.21)ms,which was smaller than that of the control group(29.1±0.33)ms,t=61.442,P<0.001.The NRS score of the observation group was(2.3±0.2)at 6 hafter operation,which was lower than that of the control group(4.3±0.7),t=17.375,P<0.001;The NRS score at 24 hafter surgery was(2.4±0.2),which was lower than that of the control group(4.1±0.6),t=17.000,P<0.001;The NRS score at 48 hafter operation was(2.1±0.3),which was lower than that of the control group(3.6±0.5),t=16.270.P<0.001.The postoperative complication rate was 7.5%in the observation group,which was lower than that of the control group(30%),χ~2=5.251,P=0.022.CONCLUSION For knee arthroplasty,ultrasound-guided saphenous nerve block is performed,which has little effect on postoperative lower extremity motor function,and can effectively control pain and has high safety.