收肌管阻滞联合浸润麻醉用于全膝关节置换患者术后镇痛的效果

Efficacy patients Zongze , of adductor canal block combined with infiltration anesthesia for postoperative analgesia in undergoing total knee arthroplasty

目的评价收肌管阻滞联合浸润麻醉用于全膝关节置换患者术后镇痛的效果。 方法择期行单侧全膝关节置换术患者60例，性别不限，年龄65～80岁，体重40～80 kg，ASA分级Ⅰ或Ⅱ级。采用随机数字表法分为3组（n＝20）：单次收肌管阻滞联合浸润麻醉组（A组）、单次股神经阻滞联合浸润麻醉组（F组）和单次浸润麻醉组（I组）。A组和F组麻醉诱导前分别在超声引导下行收肌管阻滞和股神经阻滞（0.5%罗哌卡因20 ml），完成神经阻滞后，所有患者均行全麻下喉罩通气，假体安装完毕后罗哌卡因膝关节周围局部浸润（0.2%罗哌卡因50 ml）。术后第1天早上开始每6 h口服1粒氨酚羟考酮胶囊。VAS评分〉5分，肌肉注射曲马多100 mg进行补救镇痛。于术后4、8、24、48和72 h时记录静态和动态VAS评分，测定股四头肌肌力，记录镇痛药物的使用情况及不良反应的发生情况。 结果与I组比较，F组和A组术后4、8和24 h时静态和动态VAS评分降低，术后曲马多用量降低（P〈0.05）；A组和I组术后4和8 h时股四头肌肌力高于F组（P〈0.05）。3组患者均无严重不良反应发生。 结论收肌管阻滞联合浸润麻醉用于全膝关节置换术患者术后镇痛效果确切，且对股四头肌肌力影响小。

Objective To evaluate the efficacy of adductor canal block combined with infiltration anesthesia h）r postoperative analgesia in the patients undergoing total knee arthroplasty. Methods Sixty pa- tients of both sexes, aged 65-80 yr, weighing 40-80 kg, of American Society of Anesthesiologists physi- cal status I or lI , scheduled for elective unilateral total knee arthroplasty, were divided into 3 groups （ n = 20 each） using a random number table ： single-injeetion adductor canal bloek ＋ infiltration anesthesia group （group A） , single-injection femoral nerve block ＋ infiltration anesthesia group （group F） , and infil- tration anesthesia group （group I）. Uhrasound-guided adductor canal block and femoral nerve block were performed with 0.5% ropivacaine 20 ml behwe induction of anesthesia in A ant] F groups, respec, tively. Af- ter completion of the block, all Ihe patients were ventilated through the laryngeal mask airway under general anesthesia. After installation of the knee prosthesis, local infiltration anesthesia was conducted with 0.2% ropivacalne 50 ml around the knee joint. Acetaminophen oxyeodone capsule was taken orally one pill every 6 h starting from the morning on 1st day alter surgery. When visual analogue scale （VAS） score 〉 5, tram- adol 100 mg was injected intramuscularly as reseue analgesic. At 4, 8, 24, 48 and 72 h after surgery, VAS scores at rest and （luring activity were recorded, the quadriceps strength was measured, and the requirement for analgesic drugs and development of adverse reactions were recorded, Results Compared withgroup I, VAS scores at rest and during activity were significantly decreased at 4, 8, and 24 h after surger- y, and the consumption of tramadol was significantly decreased after surgery in A and F groups （P〈O.05）. The quadriceps strength at 4 and 8 h after surgery was significantly higher in A and I groups than in group F （P〈O.05）. No patients developed serious adverse reactions in the three groups. Conclusion Adductor ca- nal block combined with infiltration anesthesia provides reliable efficacy for postoperative analgesia with little influence on the quadriceps strength in the patients undergoing total knee arthroplasty.