超声引导连续股神经阻滞在全膝关节置换术后镇痛中的应用

Application of ultrasound-guided continuous femoral nerve block for postoperative analgesia after total knee arthroplasty

目的观察超声引导下布比卡因连续股神经阻滞用于全膝关节置换术(TKA)后镇痛的效果。方法单侧全膝关节置换术患者46例随机均分为两组。A组行超声引导下布比卡因股神经患者自控神经干镇痛(PCNA);B组给予吗啡和布比卡因患者自控硬膜外镇痛(PCEA);均持续镇痛2 d。记录静息和持续被动运动时的视觉模拟疼痛评分(VAS)、肌力分级和不良反应发生情况。结果术后各时点两组静息VAS评分相仿,但A组术后48 h持续被动运动时的VAS低于B组(P<0.01)。两组患者肌力差异无统计学意义。A组术后尿潴留发生率4.3%(1/23),明显低于B组的30.4%(7/23)(P<0.01)。术后4周随访,所有患者均未出现置管部位感染及患肢感觉运动障碍。结论超声引导连续股神经PCNA用于TKA术后镇痛效果良好,不良反应少。

Objective To investigate the effects of ultrasound-guided continuous femoral nerve block（FNB） with bupivacaine for postoperative pain relief of patients after unilateral total knee arthroplasty（TKA）.Methods Forty-six patients underwent unilateral TKA were equally randomized into two groups.The patients in group A were treated by ultrasound-guided patient-controlled nerve analgesia（PCNA） of FNB with bupivacaine and those in group B were given patient-controlled epidural analgesia（PCEA） with morphine and bupivacaine.PCNA or PCEA lasted for two days.VAS pain score under rest and passive movement,muscle strength and side effects were recorded during analgesia.Results The VAS pain scores at rest had no significant difference between two groups,which during passive movement at 48 h were obviously lower in group A than those in group B（P〈0.01）.The muscle strength grades had no statistical difference between two groups.The incidence of urinary retention was lower in group A than that in group B（4.3% vs.30.4%）（P〈0.01）.Conclusion Ultrasound-guided PCNA of continuous FNB is better than PCEA for postoperative analgesia with less side effects in the patients after TKA.