股神经阻滞在前交叉韧带重建术后对疼痛和康复的影响

The Analgesia and Rehabilitation Effect of Femoral Nerve Block after Anterior Cruciate Ligament Reconstruction

目的探讨股神经阻滞在前膝交叉韧带重建术后对疼痛和康复的影响。方法将2014年6月-9月收治的62例拟行前膝交叉韧带重建术的患者随机分为股神经阻滞组和空白对照组,每组各31例。股神经阻滞组于术前3 d定时给予塞来昔布口服(200 mg,2次/d),于手术室行术侧股神经阻滞(0.75%罗哌卡因3 m L)。空白对照组只在术前3 d给予相同剂量的塞来昔布口服而不行股神经阻滞。术后两组均行24 h冰敷治疗。测量两组患者在术后2 h、1 d、2 d、7 d、14 d、28 d活动后疼痛视觉模拟评分(VAS)以及膝关节活动度。评估患者术后2、6、12、24、48 h及出院当天的股四头肌肌力等级。并记录患者在住院期间吗啡抢救的次数及用量,恶心呕吐等不良反应的发生次数等。结果前膝交叉韧带重建术后2 h^7 d股神经阻滞组活动后VAS评分低于空白对照组,差异有统计学意义(P<0.05),第14、28天差异无统计学意义(P>0.05)。膝关节活动度股神经阻滞组在2 h^28 d都优于空白对照,差异有统计学意义(P<0.05)。股神经阻滞组术后股四头肌肌力在术后2~12 h低于空白对照组,差异有统计学意义(P<0.05),24 h至出院差异无统计学意义(P>0.05)。股神经阻滞组吗啡抢救用量均少于空白对照组,差异有统计学意义(P<0.05);两组恶心呕吐等不良反应发生率差异无统计学意义(P>0.05)。结论股神经阻滞在前交叉韧带重建术后能有效减轻疼痛,并且有助于患者关节功能的康复,值得推广应用。

Objective To study the analgesia and rehabilitation effect of femoral nerve block after anterior cruciate ligament reconstruction（ACLR）. Methods During June to September 2014, 62 patients who were scheduled to undergo ACLR were randomly divided into two groups： femoral nerve block group（n=31） and control group（n=31）. All the patients were given celecoxib 200 mg（twice per day） three days before surgery. Patients in the femoral nerve block group were given a single-injection femoral nerve block（SFNB） half an hour before surgery（ropivacaine 0.75%, 30 m L）, Both of the two groups underwent ice therapy after surgery. The visual analogue scale（VAS） scores, knee joint range of motion, the muscle strength of quadriceps femoris, the side effects, complications and infection rate were recorded after the operation. Results The VAS scores were significantly lower in the femoral nerve block group within 2 hours to 7 days after surgery（P〈 0.05）, and the use of morphine was less than the control group in all the time points with statistical significance（P〈 0.05）. The muscle strength of quadriceps femoris was significantly weaker in the femoral nerve block group than the control group in the first 12 hours（P〈 0.05）. The side effects and infection rate between the two group had no significant difference（P〉 0.05）. Conclusion The femoral nerve block in anterior cruciate ligament reconstruction before surgery has a good effect on postoperative analgesia and rehabilitation, which is worth popularizing and applying.