静脉注射帕瑞昔布联合股神经阻滞用于老年病人膝关节置换术后镇痛及膝关节功能康复的效果

Efficacy of intravenous parecoxib combined with femoral nerve block for postoperative analgesia and knee functional rehabilitation in elderly patients following total knee replacement

目的评价静脉注射帕瑞昔布联合股神经阻滞用于老年病人膝关节置换术后镇痛及膝关节功能康复的效果。方法拟在全身麻醉下行单侧膝关节置换术老年病人40例，ASA分级Ⅱ级，年龄65。74岁，体重45～90k，采用随机数字表法，将其随机分为2组：单纯股神经阻滞组（FNB组，n=20）和股神经阻滞联合间断静脉注射帕瑞昔布组（FNB-Pa组，n=20）。FNB组术毕时通过股神经阻滞导管注入0．25％罗哌卡因25ml镇痛，每8h给药1次，至术后72h；FNB-Pa组在术毕前30min、术后12、24、48h分别静脉注射帕瑞昔布40mg；股神经阻滞用药同FNB组，至术后72h。于术后2、12、24、36、48及72h时记录静态时VAS评分，并于术后36、48及72h时记录动态时VAS评分。于术前、术后24、48及72h对患膝关节功能进行评分（HSS评分）；并记录有关不良反应的发生情况。结果FNB—Pa组术后静态、动态时VAS评分均比FNB组明显降低（P〈0．05）。与术前比较，术后两组病人HSS评分均明显提高（P〈0．05或0．01）；FNB-Pa组术后48、72hHSS评分明显高于FNB组（P〈0．05）。两组均未见有关不良反应发生。结论股神经阻滞联合间断静脉注射帕瑞昔布，可安全、有效地缓解老年病人膝关节置换术后静态和动态时疼痛，有助于术后关节功能的康复。

Objective To investigate the efficacy of intravenous parecoxib combined with femoral nerve block on postoperative analgesia and knee functional rehabilitation in elderly patients following total knee replacement. Methods Forty elderly patients with osteoarthritis scheduled for total knee arthroplasty under general anesthesia, aged 65-74 years, weighing 45-90 kg, ASA Ⅱ , were randomly divided into two groups （ n = 20 each）. FNB group received femoral nerve blockade for postoperative analgesia （local injection of 0.25 % ropivacaine 25 ml at the end of surgery, repeated every 8 h up to 72 h after surgery）. FNB-Pa group received the femoral nerve blockade plus the parecoxib （administered IV bolus of 40 mg 30 min before the end of surgery, 12, 24, and 48 h after surgery respectively）. Pain was scored at rest or during continuous passive motion using Visual Analog Scale （VAS）. The Hospital for Special Surgery （HSS） knee score was determinated before surgery, at 24, 48 and 72 h after surgery respectively. Side effects were also recorded in both groups. Results VAS score was significantly lower at rest and during continuous passive motion in FNB-Pa group than in FNB group （P 〈 0.05）. Compared with baseline value, HSS score increased significantly during postoperative analgesia in both groups（ P 〈 0.05 or 0.01）. HSS score were significantly higher at 48 h and 72 h after surgery in FNB-Pa group than in FNB group （ P 〈 0.05）. No severe related side effects occured in both groups. Conclusion Femoral nerve block in combination with intravenous parecoxib can safely and effectively relieve the static and dynamic pain after total knee replacement and is helpful for rehabilitation of the prosthesis knee joint function after surgery.