全膝关节置换镇痛:加巴喷丁联合连续股神经阻滞的应用效果

Total knee arthroplasty analgesia: gabapentin combined with continuous femoral nerve block

背景:传统的镇痛方法虽然能够缓解全膝关节置换患者疼痛,但是预后较差,药物依赖性较强。因此,临床上研究全膝关节置换围手术期镇痛药物具有重要的意义。目的:探讨加巴喷丁联合连续股神经阻滞对于全膝关节置换的镇痛效果。方法:从内蒙古医科大学附属医院骨科2013年10月至2014年10月收治的因膝关节骨关节炎行全膝关节置换的48例患者进行研究,均采用全身麻醉方式,且麻醉前行股神经阻滞,置换后连接镇痛泵。按照随机数字表法将患者分为两组,对照组采用多模式镇痛,试验组采用加巴喷丁联合连续股神经阻滞镇痛。采用静息、活动目测类比评分对患者疼痛程度进行评分,观察患者置换后生活质量、膝关节活动度及并发症等相关指标。结果与结论:两组置换前静息痛和活动痛差异无显著性意义(P>0.05);两组置换后疼痛随着时间延长目测类比评分降低,试验组置换后1,3,7 d以及1个月静息痛和活动痛目测类比评分均显著低于对照组(P<0.05)。试验组置换后3-7 d膝关节活动度均显著大于对照组,差异有显著性意义(P<0.05)。随访12个月,试验组日常生活能力量表(ADL)评分、躯体功能评分、心理功能评分及社会功能评分均显著高于对照组(P<0.05)。试验组并发症发生率显著低于对照组(17%,46%,P<0.05)。提示在全膝关节置换围手术期实施加巴喷丁联合连续股神经阻滞镇痛效果理想,尤其是48 h内急性疼痛者,能够促进患者膝关节功能早期恢复,且不良反应少。

BACKGROUND： Traditional analgesia method can relieve the pain after total knee arthroplasty, but the prognosis is poor and drug dependence is strong. Therefore, it is of great significance to study the analgesic drugs in perioperative period of total knee arthroplasty. OBJECTIVE： To explore the analgesic effect of gabapentin combined with continuous femoral nerve block on total knee arthroplasty. METHODS： A total of 48 patients with knee osteoarthritis receiving total knee arthroplasty in the Department of Orthopedics, Affiliated Hospital of Inner Mongolia Medical University from October 2013 to October 2014 wereenrolled in this study. Using general anesthesia, femoral nerve block was conducted before anesthesia. Analgesia pump was connected after arthroplasty. Patients were randomized to two groups. The control group received multimodal analgesia, and the experimental group received gabapentin combined with continuous femoral nerve block analgesia. Patient＇s pain was scored by using resting, activity visual analog scale. Postoperative quality of life, range of motion of knee joint and complications were observed. RESULTS AND CONCLUSION： No significant difference in preoperative resting pain and activity pain was detected between the two groups（P〉0.05）. Visual analog scale scores were decreased with time prolonged after arthroplasty in both groups. Visual analog scale scores of resting pain and activity pain were significantly lower in the experimental group than in the control group at 1, 3 and 7 days and 1 month（P〈0.05）. Range of motion was significantly larger in the experimental group than in the control group at 3-7 days after arthroplasty（P〈0.05）. Activity of daily living score, physical function score, mental function score and social function score were significantly higher in the experimental group than in the control group（P〈0.05）. The complication rate was significantly lower in the experimental group than in the control group（17%, 46%, P〈0.05）. These data indicate that during perioperative period of total knee arthroplasty, analgesic effect of gabapentin combined with continuous femoral nerve block is ideal. In particular, in patients with acute pain within 48 hours, their combination can promote early rehabilitation of the patient＇s knee, and few side effects are found.