连续股神经阻滞在全膝关节置换术后镇痛的疗效

Efficacy of postoperative analgesia by continuous femoral block in patients with total knee arthroplasty

目的比较连续股神经阻滞（CFNB）与浸润麻醉联合静脉自控麻醉（PCIA）在全膝关节置换术后患者的镇痛效果。方法单侧全膝关节置换术患者60例，采用随机数字表法，将其随机分为两组（n=30）：浸润麻醉加PCIA组（A组）、连续股神经阻滞组（B组）。分别评价术后不同时点静态与动态VAS评分，并采用改良Bromage评分评价患肢运动阻滞情况。记录术后96h内口服盐酸曲马多缓释片用量。结果与A组相比，B组术后6～48h静态VAS评分、12～48h动态VAS评分均降低，差异有统计学意义（P〈0．05）；术后两组各时点运动阻滞评分差异无统计学意义（P〉0．05）。结论CFNB可为全膝关节置换术后患者提供更加安全，有效的镇痛效果，且不影响患肢感觉和运动功能恢复。

Objective To compare the analgesia of continuous femoral nerve block（CFNB） with infiltration anesthesia and patient controlled intravenous analgesia （PCIA） in patients undergoing total knee arthroplasty. Methods Sixty patients, scheduled for selective unilateral total knee arthroplasty, were randomly divided into 2 groups （n=30） using a random number table： infiltration anesthesia and patient controlled intravenous analgesia group （group A）, continuous femoral nerve block group （group B ）. VAS at rest and during activity was recorded at different times after surgery. The motor function of the affected extremity was assessed and scored after surgery by Modified Bromage score system. The total consumption of tramadol within 96 h after surgery was recorded. Results Compared with group A, VAS at rest and during activity after surgery was significantly deereased in group B （P 〈 0.05）. No significant changes were found in motor block score of the affected extremity in two groups（P〉 0.05）. Conclusion CFNB can provide sufficient analgesia without influencing the recovery of sensory and motor function for the patients undergoing total knee arthroplasty.