两种预先镇痛方法用于全膝关节置换术后镇痛的比较

Comparison of two preemptive analgesic methods for postoperative analgesia after total knee replacement

目的观察两种预先镇痛方法用于全膝关节置换术后镇痛效果的比较。方法择期单膝关节置换术患者40例，随机分为A、B两组，每组20例，均采用喉罩全麻下手术。A组术中行局麻浸润；B组诱导前超声引导下行股神经阻滞，两组术后均行静脉自控镇痛。观察记录两组患者术中瑞芬太尼用量，术后静止和运动时的疼痛视觉模拟评分（VAS）、患者满意度、膝关节术后功能康复HSS评分及患肢膝关节术后活动度（ROM）。结果B组术中瑞芬太尼用量明显少于A组。术后6、12h两组VAS差异无统计学意义，术后24、48h的VASB组低于A组（P〈0．05）；B组患者满意度高于A组；膝关节术后3个月时功能康复HSS评分、术后14d时的ROM两组比较差异无统计学意义（P〉0.05）。结论术中局部侵润与超声引导下股神经阻滞预先镇痛的方法均可用于全膝关节置换术，后者麻醉镇痛药物用量少，患者满意度高，能有效减少术后疼痛，促进膝关节的早期功能锻炼，更适用于全膝关节置换术后镇痛。

Objective To observe the effect of two methods of preemptive analgesia for postoperative analgesia after total knee replacement. Methods Forty patients undergoing selective total knee replacement under general anesthesia were randomly divided into group A and group B, 20 cases in each group. The patients in group A received local infiltration anesthesia by the operation doctor; group B received femoral nerve block by anesthesiologists under ultrasound guidance before induction. Patient-controlled intravenous analgesia was used in all patients after the operation. Remifentanil dosage, postoperative visual analogue scale （VAS） at rest and during exercise, patients＇ satisfaction and postoperative functional rehabilitation of knee joint HSS score and knee range of motion were observed. Results The dosage of remifentanil in group B was significantly less than that in group A. There was no statistic difference in VAS at 6 and 12 h after the operation,but VAS in group B was significantly lower than that in group A at 24,48 h after the operation. There were no significant differences between the groups in knee function HSS scores after 3 months and knee ROM after 14 days （P 〉 0.05）. Conclusion The two kinds of preemptive analgesia can be used for total knee replacement. Uitrasound guided femoral nerve block can lessen analgesics dosage, reduce the pain, promote the early functional exercise of knee joint, which is more suitable for total knee replacement.