连续股神经阻滞联合单次闭孔神经阻滞对膝关节置换术后镇痛的影响

Effects of ultrasound-guided obturator nerve block combined continuous femoral nerve block for postoperative analgesia in patients undergoing total knee arthroplasty

目的评价超声引导连续股神经阻滞联合单次闭孔神经阻滞对膝关节置换术后镇痛的影响。方法 2015年6月至2016年10月期间在本院择期行单膝置换术患者80例,ASA分级Ⅰ~Ⅲ级。采用随机数表法将患者分为连续股神经阻滞联合闭孔神经阻滞组(A组)和连续股神经阻滞组(B组),每组40例。两组患者全麻诱导前均在超声引导下行股神经阻滞。随后A组采用超声引导下行闭孔神经后支与前支阻滞,分别注射0.5%罗哌卡因各7.5 m L。B组使用同样方法注射生理盐水各7.5 m L。分别记录两组患者麻醉前与注药后15 min阻滞侧大腿内收肌肌力,术后6 h、12 h、24 h、48 h静态与动态VAS评分,不良反应及患者满意度评分。结果 A组患者的闭孔神经阻滞成功率为90.0%,显著高于B组的30.0%,差异具有显著统计学意义(P<0.01);A组患者术后12 h、24 h静态VAS评分分别为(2.5±0.5)分和(2.8±0.9)分,明显低于B组相应时间点的(2.8±0.5)分和(3.3±0.5)分,两组比较差异均有统计学意义(P<0.05);A组患者术后12 h、24 h动态VAS评分分别为(3.1±0.8)分和(3.0±0.9)分,明显低于B组的(3.5±0.7)分和(3.7±0.7)分,差异具有统计学意义(P<0.05);两组患者术后恶心、头晕发生率比较差异无统计意义(P>0.05);术后满意度A组高于B组,两组比较差异有显著统计学意义(P<0.01)。结论与单纯连续股神经阻滞比较,连续股神经置管联合闭孔神经阻滞对膝关节置换术患者术后镇痛效果更好,且不增加并发症。

Objective To evaluate the efficacy of ultrasound-guided obturator nerve block combined continu- ous femoral nerve block on postoperative analgesia in patients undergoing total knee arthroplasty. Methods A total of 80 patients with the American Society of Anesthesiologists＇ （ASA） physical status Ⅰ - Ⅲ, who admitted to our hospital and scheduled for unilateral total knee arthroplasty, were selected and randomly divided into continuous femoral nerve block± ultrasound-guided obturator nerve block group （group A） and continuous femoral nerve block group （group B）, with 40 patients in each group. The femoral nerve was catheterized for block before general anesthesia in the two groups. In group A, interracial injections at 2 planes, lateral and deep to the adductor brevis muscle, were carried out with 0.5% ropivacaine 7.5 mL to block each obturator nerve branch separately. In group B, the same procedure was done with nor- mal saline. The strength of thigh adduction of the two groups was measured before nerve block and the 15 min after injection, and the static and dynamic VAS scores, adverse reactions and patient satisfaction scores at 6 h, 12 h, 24 h, 48 h postoperatively were recorded. Results The obturator nerve block success rate in the group A was 90.0%, which was significantly higher than 30.0% in the group B （P〈0.01）. The static VAS scores in the group A at 12 h and 24 h postoperatively were （2.5±0.5） and （2.8±0.9）, which were significantly lower than （2.8±0.5） and （3.3±0.5） in the group B （P〈 0.05）. The dynamic VAS scores in the group A at 12 h and 24 h postoperatively were （3.1±0.8） and （3.0±0.9）, which were also significantly lower than （3.5±0.7） and （3.7±0.7） in the group B （P〈0.05）. There was no significant difference between the two groups in the incidence of postoperative nausea and dizziness （P〉0.05）. The postoperative satisfaction of the group A was significantly higher than that of group B （P〈0.01）. Conclusion Compared with the simple continu- ous femoral nerve block, conventional continuous femoral nerve block combined with obturator nerve block has a better postoperative analgesic effect, and does not increase the complications.