持续股神经阻滞在全膝关节置换术后功能锻炼中的应用

Application of continuous femoral nerve block in function recovery after the total knee arthroplasty

目的探讨持续股神经阻滞(continuous femoral nerve block,CFNB)对全膝关节置换术(total knee arthroplas-ty,TKA)患者功能恢复的效果。方法 50例拟行单侧TKA的患者完全随机分为实验组(25例)和对照组(25例)。实验组患者术后给予CFNB,对照组患者给予持续静脉镇痛(continuous intravenous analgesia,CIA)。记录术后各时间点静止视觉模拟疼痛评分(rest visual analogue score,RVAS)、被动活动视觉模拟疼痛评分(passive visual analogue score,PVAS)和膝关节活动度(range of motion,ROM),同时观察药物的不良反应。结果①实验组术后8、12、24、48 h的RVAS和24、48h的PVAS均显著低于对照组(P<0.05);术后4h两组间RVAS的差异无统计学意义(P>0.05);②实验组术后第1、2天的ROM均显著高于对照组(P<0.05);实验组术后主动屈膝到90°所需的天数显著低于对照组(P<0.05);③实验组中药物不良反应的发生率均显著低于对照组(P<0.05)。结论持续股神经阻滞可以有效的缓解TKA患者术后早期的疼痛,促进患者膝关节的功能恢复,提高了患者的满意度,减少了CIA所产生的全身不良反应,且该方案操作简单、安全,是一种较为理想的TKA术后镇痛方法。

Objective To evaluate the effect of continuous femoral nerve block（CFNB） in function recovery after total knee arthroplasty（TKA）.Methods 50 TKA patients were randomly divided into experiment group（n=25） and control group（n=25）.All patients in experiment group were administrated with CFNB after operation while patients in control group with continuous intravenous analgesia（CIA）.Rest visual analogue score（RVAS）,passive visual analogue score（PVAS）,range of motion（ROM） of knee joint in every time point and side effects of drugs in both two groups were recorded after surgery.Results ①RVAS at 8,12,24,48 hours and PVAS at 24,48 hours after operation in experiment were significantly lower than those in control group（P 0.05）.There were no significant differences in RVAS at 4 hours after operation between two groups（P 0.05）.②ROM of knee at 1,2 days after operation in experiment group were significantly higher those in control group（P 0.05）.The time to achieve knee flexion of 90 degrees in experiment group was significantly lower than that in control group（P 0.05）.③The incidences of side effects in experiment group were significantly lower than those in control group（P 0.05）.Conclusions The continuous femoral nerve block can effectively relieve early postoperative pain of TKA patients,promote function recovery of knee joint and decrease incidence of side effects caused by continuous intravenous analgesia.CFNB is an easy,safe and alternative analgesia method after TKA.