超声引导下连续股神经阻滞联合单次前路坐骨神经阻滞用于膝关节置换术后镇痛

Ultrasound-guided a single anterior approach sciatic nerve block combined continuous femoral nerve block for postoperative analgesia in patients undergone knee arthroplasty

目的 :评价超声引导下单次前路坐骨神经阻滞能否改善连续股神经阻滞用于膝关节置换术后的镇痛效果。方法:择期拟行膝关节置换术患者40例,ASA分级Ⅰ或Ⅱ级。腰麻下行膝关节置换术后,采用随机数字表法,将其随机分为连续股神经镇痛组(F组)和单次坐骨神经阻滞联合连续股神经镇痛组(SF组),每组20例。观察术后6、12、18、24、30、36、42、48 h时患肢的疼痛强度,采用视觉模拟评分法(VAS)进行静息VAS和运动VAS评分(膝关节被动弯曲30°时的VAS评分);记录患者镇痛满意度、术后当晚及次晚由于下肢疼痛导致睡眠中断的次数;记录吗啡的消耗量;术后48 h内出现的不良反应(呕吐、瘙痒发生的例数及严重程度)。结果:与F组比较,SF组患者静息时、运动时VAS评分降低,夜间由于疼痛导致睡眠中断次数减少(均P<0.05),吗啡消耗量和不良反应减少(均P<0.05)。结论:超声下前路坐骨神经阻滞改善了患者全膝关节置换术后连续股神经镇痛的效果,促进了患者膝关节活动,提高了患者睡眠质量和患者满意度。

Objective： To evaluate the efficacy of ultrasound-guided a single anterior approach sciatic nerve block combined continuous femoral nerve block for postoperative analgesia in patients undergone knee arthroplasty. Methods： Forty ASA I or lI patients of both sexes, aged 55-80 yr, weighing 45-74 kg, with body height 152-175 cm, after knee arthroplasty under spinal anesthesia, were randomly assigned to receive ultrasound-guided continuous femoral nerve analgesia （F group） and ultrasound-guided a single sciatic nerve block combined with continuous femoral nerve analgesia （SF group） for postoperative analgesia （n=20 each）. VAS scores at rest and on movement （with passive mobilization of the knee to a 30° angle） were recorded at 6, 12, 18, 24, 30, 36, 42 and 48 h after operation. During the first 48 postoperative hours, the number of patients with vomiting, pruritus, urinary retention and awakening because of pain at night, morphine consumption and patient satisfaction scores was recorded. Results： Compared with Group F, VAS scores at rest and on movement, severity of nausea/vomiting, pruritus, morphine consumption and times of sleep interruption resulted from pain during nighttime were significantly decreased, and the overall satisfaction score was increased in group SF. Conclusion： Ultrasound-guided a single anterior approach sciatic nerve block combined continuous femoral nerve block can provide better efficacy for postoperative analgesia in patients undergone knee arthroplasty, promote knee activity, improve the quality of sleep in patients and patient satisfaction.