持续股神经阻滞用于全膝关节置换术后镇痛的效果分析

The effect of continuous femoral nerve block for postoperative TKR analgesia

目的 观察持续股神经阻滞用于全膝关节置换术后的镇痛效果、疼痛部位,并分析闭孔神经阻滞对镇痛效果的影响.方法 拟行全膝关节置换术患者60例,ASA Ⅰ ～Ⅱ级,术后均经股神经导管持续给予0.2％罗哌卡因行术后镇痛.观察术后24h的疼痛视觉模拟评分（VAS评分）,疼痛部位,股神经、闭孔神经、股外侧皮神经的阻滞情况,同时记录恶心呕吐等不良反应.根据神经阻滞情况归入A组（股神经、闭孔神经均有效）和B组（股神经有效、闭孔神经无效）,比较两组的镇痛效果.结果 术后24 h的静息和运动VAS[M （Q25～Q75）]分别为1（0～3）和5（3～6）.53％的患者表现为膝关节后侧痛.股神经、闭孔神经、股外侧皮神经同时有效者占42％（25例）.A组30例,B组14例；组间比较静息VAS评分差异无统计学意义（P＞0.05）,运动VAS评分差异有统计学意义[3（3～4.25） vs.5（3.25～6）,P＜0.05]；A组需哌替啶者（6％vs.21％）和恶心呕吐者比例（6％vs.14％）均少于B组.结论 经股神经导管持续给予0.2％罗哌卡因不能100％有效作用于股神经、闭孔神经和股外侧皮神经,术后疼痛部位主要为膝关节后侧或内侧.有效的闭孔神经阻滞有助于提高镇痛效果.

Objective To investigate the effect of continuous femoral nerve block on pain relief after total knee replacement and the efficacy of obturator nerve blockade.Methods Sixty patients who underwent total knee replacement were studied.Postoperatively,0.2％ ropivacaine 5 ml/h was given to all patients through femoral nerve catheter,in addition,5 ml （lock time 30 min） as was given as patient controlled bolus.24 h after operation,the VAS score,location of pain,ratio of blockade of femoral nerve,obturator nerve and lateral femoral cutaneous nerve were noted.The patients were assigned into group A （both femoral and obturator nerve were blocked） and group B （femoral nerve was blocked but not obturator nerve）.The analgesia effect of the two groups was compared.Results 24 h after operation,the VAS[M （Q25～Q75）] during the rest and movement was 1 （0～3） and 5 （3～6） respectively.The ratio of patients complained of pain at the back of knee was 53％.The ratio of patients with the main three nerve blocked was 42％.The analgesia effect of group A was better than that of group B.Conclusion Continuous infusion of 0.2％ ropivacaine through femoral nerve can not block femoral nerve,obturator nerve and lateral femoral cutaneous branch completely at the same time.The main site of pain is located at the back of knee.Obturator blockade can improve the analgesia effect after total knee replacenent.