膝关节置换术后连续股神经阻滞镇痛的短期临床效果

Short-term analgesic effects of continuous femoral nerve block after total knee arthroplasty

目的：通过术后不同镇痛方式的对比研究，探讨简单、规范、有效的围手术期镇痛方案。方法选择2011年6月至2013年12月行初次单侧全膝关节置换患者共248人，随机分为阻滞组（124人）及静脉组（124人）。阻滞组在术前进行股神经穿刺并留置导管，术后48 h内持续镇痛、后期（至术后7天）负荷剂量镇痛；静脉组留置静脉自控镇痛泵至术后48 h，后期采取肌肉注射药物镇痛。观察指标包括：术后6、12、24、48 h以及3～7 d的膝关节疼痛程度（静息、活动）；术后3～7 d患侧膝关节活动度；术后不良反应发生率。结果在12、24、48 h，阻滞组的疼痛程度平均小于静脉组，且差异有统计学意义（P＜0.05）；术后3～7 d的静息痛两组之间差异无统计学意义（P＞0.05），而阻滞组的活动痛疼痛程度平均小于静脉组，且差异有显著统计学意义（ P＜0.01）；阻滞组术后3～7 d膝关节的活动度明显大于静脉组，且差异有统计学意义（ P＜0.05）；静脉组出现副反应的比率明显大于阻滞组，且差异有统计学意义（ P＜0.05）。结论围手术期多模式联合镇痛已经成为共识；股神经阻滞镇痛在围手术期临床效果明显，具有操作方便、安全性高、副作用少、利于锻炼等优点。

Objective To explore a simple , specific and effective perioperative analgesic solution for the total knee arthroplasty （TKA）.Methods From June 2011 to October 2013, 248 patients who underwent the primary total knee arthroplasty in the department of Orthopedics , Beijing Chao-yang Hospital were selected , and randomly divided into two groups according to the different pain-relief protocols： the＆amp;nbsp;block group （124 knees） and the intravenous group （124 knees）.The intensity of pain was assessed by Visual Analog Scale （VAS） in 6, 12, 24, 48 hours and three to seven days after the operation .The knee range of motion （ ROM） in three to seven days after the operation was compared between the two groups . The incidences of the side effects such as nausea , vomiting, urinary retention, and catheter-related problems were investigated .Results The VAS scores in the block group were lower than that in the intravenous group at 12, 24 and 48 hours after the operation（P〈0.05）.The VAS scores of the pain during avtivity in the block group was significantly lower than that in the intravenous group in three to seven days after the operation （ P〈0.01）; yet there was no significant difference of the rest pain between the two groups.The ROM of the block group was significant larger than that of the intravenous group in three to seven days after the operation （ P〈0.05 ） .Significantly more side effects such as urinary retention , nausea and vomiting were observed in the intravenous group （ P 〈0.05 ） .Conclusion The multimodal pain control protocol has become a consensus in TKA .Analgesia by continuous femoral nerve block can provide effective pain relief after TKA.