人工全膝关节置换术康复锻炼期镇痛方式对关节功能恢复的影响

EFFICACY OF DIFFERENT ANALGESIC METHODS DURING THE POSTOPERATIVE REHABILITATION EXERCISES UNDERGOING TOTAL KNEE ARTHROPLASTY

目的:观察不同镇痛方法对人工全膝关节置换术后早期功能锻炼的镇痛作用及早中期关节功能恢复的影响。方法:择期拟行单侧全膝关节置换术患者80例,术前诊断为膝关节骨性关节炎,年龄40~78岁,性别不限,术前ASA分级I^II级。根据康复期镇痛方法不同,采用随机数表法,将患者随机分为2组(n=40):生理盐水组(NS组,n=40):术后3天内采用股神经周围置管0.2%罗哌卡因连续镇痛,术后4~7天功能锻炼期于康复运动前30 min经股神经置管单次推注生理盐水10 ml;股神经阻滞组(FA组,n=40):术后3天内采用股神经周围置管0.2%罗哌卡因连续镇痛,术后4~7天功能锻炼期于康复运动前30 min经股神经置管单次推注0.2%罗哌卡因10 ml。由未参与患者分组及研究操作的疼痛管理小组成员对患者术后疼痛评分、康复运动情况进行观察。患者康复锻炼过程中疼痛视觉模拟评分(visual analogue scale,VAS)>4时,口服泰勒宁1#进行镇痛补救。记录术毕即刻、术后24小时、48小时、72小时静息和运动时VAS疼痛评分,术后4~7天功能锻炼期持续被动运动(Continuous Passive Motion,CPM)时的VAS疼痛评分,持续被动运动角度和并发症发生率以及术后8周复查时膝关节外科学会评分(Keen Society Score,KSS)。结果:在术后4-7天关节康复锻炼期,FA组患者持续被动运动的VAS疼痛评分低于NS组,FA组的CPM运动角度明显高于NS组;FA组达到关节持续被动运动出院目标角度90度的时间明显短于NS组;两组患者术后8周关节膝关节KSS差异无统计学意义,恶心呕吐及感觉麻木发生率的差异无统计学意义。结论:功能锻炼期股神经阻滞镇痛可以明显减轻人工全膝关节置换术后早期功能锻炼期时关节持续被动运动时的疼痛,增加关节被动运动角度,促进关节功能康复,明显缩短人工关节达到关节被动运动目标角度的时间,并且不增加恶心呕吐等副作用的发生率,是一种令人满意的功能锻炼期镇痛方法,。

Objective： To observe the effect of different analgesic methods on postoperative rehabilitation pain after＇total knee arthroplasty （TKA） surgery in the medium and the early to middle recovery period. Methods： 80 adult patients, ASA I-U, diagnosed as Knee Osteoarthritis undergoing TKA surgery were randomly divided into two groups： group FA and NS. Group FA received continuous femoral nerve block analgesia the first three days after operation with 0.2% Ropivacaine and 0.2% Ropivacaine administerd 10 ml twice a day 30 minutes before the functional training; group NS received continuous femoral nerve block analgesia the first three days after operation with 0.2% Ropivacaine and normal saline 10 ml twice a day 30 minutes before the functional training. VAS Pain scores were obtained at rest and during continuous passive motion （CPM）, the degree of the continuous passive motion, complications and the KSS score 8 weeks after the surgery were assessed and recorded. Results： The VAS pain scores of FA group during the CPM were lower than the NS group and achieved a greater range of motion during CPM. The time to achieve the target of discharge （90＊） was significantly in FA group. There were no significant different difference increase in the occurrence of nausea and vomiting, nor in KSS scores 8 weeks after the surgery. Conclusion： The femoral nerve block on postoperative rehabilitation pain after total knee arthroplasty （TKA） surgery reduces pain scores during the CPM in movement, and a greater range of motion without additional complications. Continuous femoral nerve block may shorten the length of hospital stay for the patient and reduce time needed in achieving the discharge target. Thereby this is a satisfactory pain management choice during the rehabilitation stage of total knee arthroplasty surgery.