不同浓度罗哌卡因配伍连续股神经阻滞用于全膝关节置换术后镇痛的效果

Efficacy of Different Local Anesthetic Concention of Ropivacaine in Patient Receiving Continuous Femoral Nerve Block for Postoperative Rehabilitation Pain after Total Knee Arthroplastic Surgery

目的:观察不同浓度罗哌卡因配伍连续股神经阻滞用于全膝关节置换术后镇痛的效果。方法:选择美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级行单侧全膝关节置换患者60例,随机分为2组:高浓度组(0.25%罗哌卡因)和低浓度组(0.125%罗哌卡因),每组30例。所有患者均实施气管插管全身麻醉,术后采用连续股神经阻滞进行镇痛。记录患者在静息、主动和持续被动功能训练时的视觉模拟评分(VAS)疼痛评分,同时记录开始下床活动时间,肌力分级和并发症发生率。结果:高浓度组患者在术后6h、24h、48h及72h的静息、主动和持续被动功能训练时的VAS疼痛评分均显著低于低浓度组患者(P<0.05);2组患者下床活动时间无显著差异[(25±2)h比(27±4)h,P>0.05];2组患者的术后24～72h肌力评分平均大于3级;2组术中和术后均未出现并发症。结论:相对于0.125%的罗哌卡因,采用浓度0.25%的罗哌卡因配伍连续股神经阻滞可提供满意的术后镇痛。

Objective：To evaluate the efficacy of different concentration of ropivacaine in patient receiving continuous femoral nerve block for postoperative rehabilitation pain after total knee arthroplastic surgery.Methods：Sixty ASAⅠorⅡ patients aged 40-80yr undergoing unilateral total knee arthroplastic（TKA） surgery were randomly allocated into 2 groups（n=30 each）,the high concentrion（0.25%ropivacaine） group（Group H）and the low concentrion（0.125%ropivacaine） group（Group L）.All patients received general anesthesia with tracheal intubation.After operation,all patients received continuous femoral nerve block for postoperative rehabilitation pain.visual analog scores（VAS） during rest,initiative exercise and continuous passive movement（CPM）,time of first walk,muscle strength grades and complications were recorded.Results：The VAS during rest,initiative exercise and CPM at all time points in Group H were significantly lower than those in Group L.There was no significant difference about the time of first walk between the two groups[（27±4）h vs.（25±2）h].Average muscle strength grades during postoperative 24-72 h in two groups were above grade 3.Conclusions：Compare with 0.125%ropivacaine,0.25% ropivacaine can provide satisfactory postoperative rehabilitation pain.