股神经阻滞与静脉镇痛在膝关节置换术后镇痛的研究

CLINICAL STUDY OF CONTINUOUS FEMORAL NERVE BLOCK VERSUS PATIENTS-CONTROLLED INTRAVENOUS ANALGESIA AFTER TOTAL KNEE ARTHROPLASTY

目的：比较连续股神经阻滞与静脉自控镇痛在膝关节置换术后的镇痛效果.方法：选择30例行膝关节置换术的患者（男4例,女26例）,年龄51～75岁.随机分为两组,连续股神经阻滞组（continuous femoral nerve block,FNB）15例,与静脉自控镇痛组（PCA） 15例.所有的患者以前均未做过膝关节手术.镇痛效果采用VAS视觉评分（0分为无痛,10分为剧烈疼痛）.记录术后静息及运动时的VAS评分,住院天数以及使用镇痛泵之后的不良反应.结果：FNB组各时间点的静息和活动评分均略低于PCA组,但是无显著统计学差异,住院天数也无显著统计学差异.PCA组有4例发生恶心呕吐,明显高于FNB组.结论：PCA组与FNB组均可以缓解患者的术后疼痛,但是PCA的副反应发生率较高.

Objective： To compare the efficacy of continuous femoral nerve block （FNB） with local anaesthetics through a catheter and patients-controlled analgesia （PCA） with intravenous fentanyl on patients undergoing total knee arthroplasty （TKA）. Methods： 26 women and 4 men aged 51 ~ 75 years with matched characteristics underwent TKA and received either continuous FNB with local anaesthetics through a catheter （n = 15） or PCA with intravenous fentanyl （n = 15）. All of the patients had previous experiences of knee surgery. Quality of analgesia was assessed based on pain intensity （visual analogue scale,VAS） where 0 means no pain and 10 means utmost imaginable pain）. In addition, joint mobility and length of hospital stay was assessed, and any adverse reactions or side effects were noted. Results： Both groups of patients had satisfactory postoperative pain relief, and similar in terms of length of hospital stay. Patients in the PCA group had significantly more side-effects （nausea, vomiting and dizziness）. No patients had any surgical complication. Conclusion： Both FNC and PCA provide reliable pain control. However, the use of PCA is limited by obvious adverse reactions.