连续股神经阻滞镇痛对老年人全膝关节置换术后康复功能的影响

Effect of continuous femoral nerve block and epidural analgesia on rehabilitation after total knee arthroplasty surgery

[目的]比较连续股神经阻滞和硬膜外阻滞在全膝关节置换术后镇痛的效应和对康复功能的影响，寻求最佳的镇痛方案。[方法]选择ASAⅠ～Ⅱ拟行单侧全膝关节置换术老年患者50例，随机分为2组：连续股神经阻滞镇痛（CFNB）组和硬膜外镇痛（CEA）组。术后留置导管连接0．2％罗哌卡因＋1ug／ml舒芬太尼止痛泵维持镇痛。记录术后6h、12h、24h、48h静息状态和术后24h、48h持续被动运动训练时VAS疼痛评分；观测术后12h、24h患肢主动关节屈曲角度；记录术后6h储血罐内的引流量及术前、术后24h、48h血红蛋白浓度及副作用的发生率。[结果]术后各时点两组患者静息VAS无统计学差异，CFNB组术后24h、48h持续被动功能训练时的VAS疼痛评分（3．86±0．93和3．93±0．78），均明显低于CEA组患者（P〈0．01）；与CEA组比较，患肢主动关节屈曲角度、术后引流量和各时点血红蛋白浓度无统计学意义。两组副作用的发生率相似。[结论]连续股神经阻滞镇痛在持续被动运动时镇痛效应优于硬膜外镇痛，安全性高，操作简便，是TKA术后又一较为理想的镇痛方法。

[ Objective] To compare the effects of continuous femoral nerve block （CFNB） and epidural analgesia （CEA） on rehabilitation after total knee arthroplasty （TKA） surgery. [ Methods] Fifty patients undergoing unilateral TKA surgery were randomly divided into group CFNB （n = 25 ） and group CEA （n = 25 ） . All patients were received unilateral spinal anesthesia with 0. 5% dicaine and given analgesia with 0. 2 % ropivacaine with 1ug/ml sufentanil. VAS pain scores during rest and continuous passive movement （CPM） at each time point was recorded. Other parameter such as the angle of initiative flections, blood loss at 6 h post operation, the concentration of serum hemoglobin at 24 h, 48 h and side effect were recorded. [ Results ] The VAS pain scores during test had no significant difference between two groups. The VAS scores of CPM at 24 h and 48 h in group CFNB were obvious lower （3.68±0. 93 and 3.93 ±0. 78） than those in group CEA. The initiative flections were similar at 12 and 24 hours after operation. The concentration of hemoglobin at 6 h after operation was lower than that before operation. After reinfusion it was increased but did not reach the level before operation. The incidence of side effects was not noted in both groups. [ Conclusion] After TKA surgery, the continuous femoral nerve block can provide better pain relief. No adverse impact on rehabilitation movement of operated legs or blood loss and has less side effect. Therefore, it should be considered an alternative analgesia method after TKA.