依托考昔联合超声引导下股神经阻滞用于膝关节镜日间手术后的镇痛效果

Analgestic effect of etoricoxib combined with ultrasound-guided femoral nerve blockafter day surgery of knee arthroscopy

目的观察依托考昔联合超声引导下股神经阻滞用于膝关节镜日间手术后的镇痛效果。方法选择择期行单侧膝关节镜日间手术患者48例,男27例,女21例,年龄18～65岁,ASAⅠ或Ⅱ级,随机分为依托考昔+股神经阻滞组(EF组)和静脉镇痛组(C组),每组24例。EF组患者入室前口服依托考昔120mg,麻醉诱导前行患侧超声引导下股神经阻滞,注射0.15%罗哌卡因30ml。C组将舒芬太尼1.5μg/kg配制成50ml行PCIA。记录术后1、3、6、12、18h患者安静和屈膝运动时的VAS疼痛评分和Ramsay镇静评分。评估术前和术后患肢股四头肌肌力。记录补救镇痛例数及不良反应发生情况等。结果术后1、3hEF组静息VAS评分明显低于C组(P<0.05),术后1、3、6、12hEF组屈膝运动VAS评分明显低于C组(P<0.05);两组术后各时点Ramsay评分差异无统计学意义;与C组比较,EF组患者在术后1、3h肌力明显降低(P<0.05);两组补救镇痛例数差异无统计学意义;两组头晕、恶心、嗜睡、尿潴留和瘙痒发生率差异无统计学意义。结论术前口服依托考昔联合0.15%罗哌卡因单次股神经阻滞可作为膝关节镜日间手术预防性镇痛的理想选择。

Objective To investigate the analgestic effect of etoricoxib combined with ultrasound-guided femoral nerve block after day surgery of knee arthroscopy.Methods Forty-eight patients scheduled for elective unilateral knee arthroscopy day surgery,27 males and 21 females,aged 18-65 years,falling into ASA physical statusⅠorⅡ,were randomly divided into etoricoxib+femoral nerve block group(group EF)and intravenous analgesia group(group C).Patients in group EF received 120 mg of etoricoxib before entering the room.Ultrasound-guided femoral nerve block was operated before anesthesia induction and 30 ml of 0.15% ropivacaine was injected.In group C,1.5μg/kg of sufentanil was formulated into 50 ml of PCA pump.The VAS score and Ramsay sedation scores of patients with quiet and knee flexion were observed and recorded at 1,3,6,12 and 18h after the operation.The quadriceps muscle strength of the limbs was assessed before surgery and at various time points after surgery.The number of remedial analgesics,the amount of medication,adverse reactions were recorded.Results The resting VAS of the group EF was significantly lower than that of group C at 1h and 3h after operation(P<0.05).There was no significant difference in Ramsay scores between the two groups.Compared with group C,the muscle strength of the group EF was lower at the 1h and 3h after operation(P<0.05).There were no significant differences in the number of remecial analgesics and the incidence of dizziness,nausea,lethargu,urinary retention,itching between the two groups.Conclusion Preoperative oral etoricoxib combined with low-concentration ropivacaine femoral nerve single-block multi-mode analgesia may be an ideal choice for postoperative analgesia of knee arthroscopy day surgery.