全膝关节置换术后连续股神经阻滞镇痛效果观察

Analgesic efficacy of continuous femoral nerve block used after total knee arthroplasty

目的观察连续股神经阻滞镇痛在单侧全膝关节置换术(TKA)术后的镇痛效果。方法 40例拟行单侧TKA术的膝关节骨性关节炎患者采用随机数字表法分为A、B组,各20例。两组均于全身麻醉下行单侧TKA。A组于全身麻醉前加用股神经传导阻滞,B组则于单侧TKA术后连接自控性输注泵。根据视觉模拟评分法(VAS)评估两组术后6、12、24、36、48 h静息状态及运动状态下患者疼痛程度。观察两组追加吗啡情况,计算累计剂量。观察两组术后48 h时患肢股四头肌肌力,观察两组术后第2、3、4天患侧膝关节的屈伸活动度。观察两组头晕、恶心呕吐、尿潴留、心动过缓等术后并发症发生情况。结果术后6、12、24、36、48 h时A组患者静息状态及运动状态VAS评分均低于B组,P均<0.05。术后48 h时A组吗啡累计用量低于B组,P<0.05。术后第2、3、4天A组患侧膝关节屈伸活动度均大于B组,P均<0.05。A、B组不良反应发生率分别为15%(3/20)、55%(11/20),二者比较,P<0.05。结论与经静脉自控镇痛比较,单侧TKA术后应用连续股神经阻滞镇痛方法镇痛效果好,膝关节功能恢复好,且不良反应少。

Objective To observe the analgesic efficacy of continuous femoral nerve block（ CFNB） used after total knee arthroplasty（ TKA）. Methods Forty patients undergoing unilateral TKA were randomly divided into two groups：group A and group B,20 cases in each. Patients in group A took the femoral nerve block before TKA. Patients in group B received the controlled infusion pump after TKA. Visual analogue scale（ VAS） was used to evaluate perioperative pain score at 6,12,24,36 and 48 h after TKA. The cumulative dosage of morphine of both groups were recorded. We observed the limb femoral muscle strength of patients in both groups at 48 h after TKA. The range of motion of the two groups were observed and recorded on the 2nd,3rd and 4th day after TKA. Meanwhile,the dizziness,nausea,vomiting,urinary retention,tachycardia and other postoperative complications occurred in both groups after TKA were observed. Results At 6,12,24,36 and 48 h,the VAS scores of group A were lower than those of group B（ all P 〈0. 05）. The dosage of cumulate morphine of group A was lower than that of group B（ P 〈0. 05）. The average range of motion of group A on day 2,3 and4 after TKA was larger than that of group B（ all P 〈0. 05）. The incidence of adverse reactions of group A was 15%（ 3/20）,which was also lower than that of group B〔55%（ 11/20） 〕（ P 〈0. 05）. Conclusion CFNB has superior early analgesic effect to patient-control intravenous analgesia after TKA,as well as fewer adverse reactions and better knee function recovery.