超声引导下连续收肌管阻滞联合关节周围浸润镇痛对全膝关节置换术后镇痛的效果

Effects of ultrasound guided continuous adductor canal block combined with periarticular local infiltration in the postoperative analgesia undergoing total knee arthroplasty

目的比较连续收肌管阻滞（CACB）和CACB联合膝关节周围浸润镇痛（PLIA）对全膝关节置换术（TKA）术后镇痛的效果。方法选择择期行单侧全膝关节置换术患者60例，随机分为阻滞组和联合组，每组30例。麻醉诱导前，两组患者均接受超声引导下的CACB，以视觉模拟评分（VAS）评价患者疼痛程度，并记录两组患者术后静息和活动时的疼痛评分及膝关节活动度。结果两组患者术后静息时膝关节VAS评分在各时点差异均无统计学意义（P〉0．05），被动运动时联合组VAS评分在术后4h后明显低于阻滞组（P〈0．05）。与阻滞组比较，联合组被动屈膝90°角时和主动直腿抬高时均明显缩短（P〈0．05）。结论CACB联合PLIA的镇痛方式可以降低膝关节术后疼痛评分，减少被动运动疼痛，缩短术后被动运动时间，从而促进患者早期活动与患肢功能恢复。

Objective To compare the efficacy of postoperative analgesic between ultrasound guided continuous adductor canal block （CACB） and CACB combined with periarticular local infiltration analgesia （PLIA） in the patients undergoing total knee arthroplasty （TKA）. Methods Sixty patients undergoing TKA under general anesthesia were randomly divided into CACB group and CACB combined with PLIA group （PLIA group）, 30 cases in each group. VAS at rest and movement, mobility of knee join and complications after the operation were recorded. Results There was no significant difference in VAS of knee joint at rest at each time point between the two groups （P〉0.05）. VAS in group PLIA was significantly lower than that in group CACB during passive movement at 4 hours after the operation （P〈0.05）. The time of passive flexing knees to 90° and active straight-leg raising in the PLIA group were significantly shorter than those in the CACB group （P〈O.05）. Conclusion CACB combined with PLIA is better than CACB in decreasing the postoperative pain of the knee joint, relieving the passive movement pain, shortening the passive movement time, promoting the patients＇ early movement and function recovery.