膝关节局部注药复合股神经阻滞在全膝关节置换术后镇痛中的应用

Application of local drug injection combined with femoral nerve block for postoperative management of pain in total knee arthroplasty

目的观察膝关节局部注药联合股神经阻滞镇痛方式用于膝关节置换术（TKA）后康复镇痛的效果。方法将30例ASAⅠ-Ⅲ级拟行单侧全膝关节置换术的患者随机分为3组，每组10例，A组镇痛措施采用股神经阻滞，B组采用关节腔局部阻滞，C组采用股神经阻滞加关节腔局部阻滞。观察3组患者静息、活动时的疼痛视觉模拟评分（VAS）、关节活动度、肌力分级和并发症发生率。结果C组术后4、12、24、36、48h静息痛和被动活动痛VAS评分均低于A和B组（P〈0．05），C组在术后的第3天膝关节屈伸活动度较A、B组有较好恢复（P〈0．05）。两组副作用无差别。结论TKA关节周围注药联合股神经阻滞可在术后早期减轻疼痛、改善关节活动度、促进康复，且不会增加副作用。

Objective To observe the clinical efficacy of local drug injection combined with femoral nerve block for postoperative man agement of pain in total knee arthroplasty. Methods Thirty patients who received unilateral total knee arthroplasty were randomly divid ed into 3 groups （n = 10）, ASA I - Ⅲ. According to analgesic protocol, the patients were divided into three groups：Group A （the meas ures of postoperative analgesic was femoral nerve block）, Group B （ the measures of postoperative analgesic was inrta - articular or periar ticular injection of cocktail therapy ） and Group C （ the measures of postoperative analgesic was group B combined with group C）. The postoperative visual analog scores （VAS）, range of motion（ ROM）, the ability of straight leg raising and the incidence of side effect were recorded and compared between the three groups. Results In Group C, the VAS scores of rest pain or passive activities pain were lower than those in group A and group B （P 〈 0.05） ; In the first three days of the postoperative knee range of motion, group C was recovered better （P 〈 0.05） compared with group A and B. There were no differences in side effects in three groups. Conclusions - The method of local drug injection combined with femoral nerve block in the early postoperative may well control pain of TKA, and improve joint activi ties and promote rehabilitation,without increasing side effects.