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

Clinical observation of continuous anterior lumbar plexus blockade for postoperative analgesia of total knee prosthesis

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(TKP)术后镇痛的效果。方法:选择ASAI～Ⅱ级,择期在全身麻醉下行TKP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50h。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、48h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 （TKP）. Methods： Forty- five ASAⅠ-Ⅱ patients undergoing unilateral TKP under general anesthesia were selected.They were randomly divided into three groups.The patients in group A received continuous intravenous fentanyl. The patients in group B were given 0.2% ropivacaine through a nerve block catheter, and the patients in 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 in 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 TKP surgery, modiffled continuous anterior lumbar plexus block with 0.15% or 0.2% ropivacaine can provide adequate pain relief, slight impact on muscle strength and decrease side effects.