“Shamrock method”超声引导连续腰丛神经阻滞用于老年患者全膝关节置换术后镇痛的临床观察

Efficiency of ultrasound-guided“Shamrock” continuous lumbar plexus block for postoperativeanalgesia in the elderlyafter total knee arthroplasty

目的：评价“Shamrock method”超声引导联合刺激仪定位下连续腰丛神经阻滞与连续股神经阻滞对全膝关节置换术后镇痛的临床效果。方法采用开放、随机对照的研究方法，选择解放军总医院2014年6月至2014年12月择期行单侧全膝关节置换术的老年患者80例，年龄65～87岁，美国麻醉医师协会（ASA）分级Ⅱ～Ⅲ级，随机均分为连续腰丛神经阻滞组（L组）和连续股神经阻滞组（F组）。L组患者采用“Shamrock method”超声引导联合刺激仪定位下行腰丛神经阻滞，F组则采用超声引导联合刺激仪定位下行股神经阻滞，两组穿刺成功后均注入0.2%罗哌卡因30ml并留置导管,术后镇痛泵背景剂量为0.2%罗哌卡因5ml/h。记录术后6，12，24，48h时静息状态视觉模拟评分法（VAS）评分，术后24，48h膝关节功能锻炼时VAS评分和肌力评分；记录术后局麻药中毒、恶心呕吐和神经损伤等不良反应的发生情况。结果与L组相比较，F组术后各时点静息状态和功能锻炼VAS评分均明显增高（P＜0.05），肌力评分两组间差异无统计学意义（P＞0.05）。两组均未见局麻药中毒、神经损伤发生，且恶心呕吐等不良反应发生率两组间差异无统计学意义。结论“Shamrock method”超声引导联合刺激仪定位下连续腰丛神经阻滞对于老年患者全膝关节置换术后镇痛的临床效果优于连续股神经阻滞。

ObjectiveTo evaluate the efficacy of the“Shamrock method”,ultrasound combined withstimulator guided continuous lumbar plexus nerve blockfor postoperative analgesia intheelderlyafter total knee arthroplastyby compared with continuous femoral nerve block.MethodsAn open, randomized, controlled trial was conducted on 80 ASAⅡ orⅢ patients （65 to 87 years old） undergoing total knee arthroplasty in our hospital from June to December 2014. The patients were randomly assigned to continuous lumbar plexus nerve block group （L group） and continuous femoral nerve block group （F group）.The patients of the formergroupreceived continuous lumbar plexus nerve blockby ultrasound guided“shamrock” and electronic nervestimulator,and those of the latter group receivedcontinuous femoral nerve block byultrasound guiding combined withstimulator.After the nerve block catheters were inserted and30ml 0.2% ropivacaine was given,allpatients receivedpatient-controlled analgesia（PCA） after the surgery with0.2%ropivacaine 5ml/has the background dose. VisualAnalogueScale （VAS） wasemployed to evaluate the pain level at 6,12,24 and48h, postoperatively. VASpain scores were recorded at 24 and48h, postoperatively, during functional excise and muscle strength.The toxic reaction,nausea and vomiting, and nerve damage were recorded after surgery.Results TheVASscores during rest and functional excise weresignificantly higher inFgroupthanin Lgroup （P〈0.05）, but there was no difference in the muscle strength between the2 groups （P〉0.05）.Nolocal anesthetic toxicityor nerve damage was founded inthe both groups, and there was no statisticaldifference in the incidence of side effect such as nausea and vomiting during postoperative analgesia. Conclusion The ultrasound-guided“shamrock” combined withstimulatorforcontinuous lumbar plexus nerve block issuperior to continuous femoral nerve block in analgesiafor postoperative analgesiain the elderlyaftertotal knee arthroplasty.