收肌管阻滞与表面麻醉用于患者膝关节镜术后镇痛效果的比较

Comparison of adductor canal block with topical anesthesia for postoperative analgesia in patients undergoing arthroscopic knee

目的比较收肌管阻滞与表面麻醉用于患者膝关节镜术后镇痛的效果。方法选择拟行单侧膝关节镜下半月板切除术的患者60例，性别不限，年龄18～64岁，BMI18～30kg／m^2，ASA分级I或Ⅱ级，采用随机数字表法分为2组（n=30）：引导收肌管阻滞组（ACB组）和表面麻醉组（TA组）。ACB组术前30min行超声引导收肌管阻滞，注射0．2％罗哌卡因20ml；TA组手术结束前5rain关节腔注射0．25％罗哌卡因20ml。记录术后12h内镇痛有效（VAS评分≤4分）和股四头肌肌力减弱（徒手肌力法评估术后股四头肌肌力0—2级）的发生情况、相关并发症（局麻药中毒、穿刺部位出血、血肿等）、术后恶心、呕吐和苏醒延迟的发生情况。结果与TA组比较，ACB组术后12h内镇痛有效率升高（P〈0．01），股四头肌肌力减弱发生率、恶心呕吐发生率差异无统计学意义（P〉0.05），2组均未见局麻药中毒、穿刺部位出血、血肿及苏醒延迟发生。结论收肌管阻滞用于膝关节镜手术后镇痛的效果优于表面麻醉。

Objective To compare adductor canal block （ACB） with topical anesthesia for postoperative analgesia in the patients undergoing arthroscopic knee surgery. Methods Sixty patients of both sexes, aged 18-64 yr, with body mass index of 18-30 kg/m^2, of American Society of Anesthesiologists physical status I or II , scheduled for elective arthroscopic meniscectomy, were divided into 2 groups （n = 30 each） using a random number table： ACB group and topical anesthesia group （TA grnup）. In group ACB, 0.2% ropivacaine 20 ml was injected into the adductor canal under the guidance of ultrasound at 30 rain before operation to perform ACB. In group TA, 0.25% ropivacaine 20 ml was injected into the articu- lar cavity at 5 min before the end of operation. The development of effective analgesia （ VAS scores ≤ 4） and weakened quadriceps femoris muscle strength （muscle strength 0-2 grade, post-operative muscle strength was assessed by using manual muscle testing） , related complications （ local anesthetic intoxica- tion, bleeding at the puncture site and hematoma） and occurrence of postoperative nausea, vomiting and delayed emergence were recorded. Results Compared with group TA, the rate of effective analgesia within 12 h after surgery was significantly increased （P〈0.01） , and no significant change was found in the incidence of weakened quadriceps femoris muscle strength, nausea and vomiting in group ACB （P〉0.05）. Local anesthetic intoxication, bleeding at the puncture site, hematoma or delayed emergence was not observed in the two groups. Conclusion ACB produces better efficacy for postoperative analgesia than topicalanesthesia in the patients undergoing arthroscopic knee surgery.