连续前路腰丛神经阻滞在膝关节置换术后镇痛中的应用

Continuous anterior lumbar plexus block for postoperative pain after total knee arthroplusty

目的观察连续前路腰丛神经阻滞用于全膝关节置换（TKA）术后镇痛和康复锻炼的效果。方法选择择期在全身麻醉下行TKA术的患者40例，随机分为2组：连续前路腰丛神经阻滞组（Ⅰ组）和静脉持续芬太尼组（Ⅱ组），每组20例。Ⅰ组患者通过连续前路腰丛神经阻滞导管持续输注0．2％罗哌卡因镇痛，Ⅱ组患者术后持续静脉输注芬太尼镇痛，均持续镇痛50h。记录静息及功能锻炼时视觉摸拟评分（VAS）、肌力分级、镇静程度及副作用发生。结果Ⅰ组患者术后8、12、24、48h静息时和功能锻炼时VAS评分均明显低于Ⅱ组，（P〈0．05或P％0．01）。两组患者肌力均良好，无统计学差异。Ⅱ组患者镇静过度、恶心及镇痛不全发生率均较高。结论连续前路腰丛神经阻滞用于全膝关节嚣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 on postoperative rehabilitative exercise and pain after total knee arthroplasty（TKA） surgery. Methods Forty patients undergoing unilateral TKA under general anesthesia were randomly divided into two groups. 0.2% ropivacaine were given continuously via the lumbar plexus nerve block catheter in group Ⅰ,and continuous intravenous fentanyl in group n. All patients were maintained analgesia for 50 hours. Visual analogue scale （VAS） during rest and movement, muscle strength grades,Ramsay sedation scores and complications were recorded. Results The VAS during rest and movement at postoperative 8,12,24,48 h in group Ⅰ were significantly lower than those in group Ⅱ, P〈0.05 or P 〈0.01. Compared with group Ⅱ, a significantly lower incidence of side effects happened in group Ⅰ. The muscle strength grades was no statistically difference in both groups, which was maintained sat- isfactory. Conclusion After TKA surgery, the continuous anterior lumbar plexus block can provide adequate pain relief, slight impact on muscle strength and fewer side effects.