经皮电刺激耳神门穴对全膝关节置换后镇痛效果的影响

Analgesic effect of transcutaneous electrical stimulation at the auricular Shenmen(H7) point after total knee arthroplasty

背景:经皮穴位电刺激镇痛效果良好,目前缺乏应用于全膝关节置换术后镇痛有效性和安全性的评估。目的:评价经皮电刺激耳神门穴对全膝关节置换术后镇痛的影响。方法:纳入40例ASAⅠ-Ⅲ级择期在全身麻醉联合股神经阻滞下行全膝关节置换的患者,随机分为试验组和对照组,每组20例。试验组患者麻醉前、术后8,16,36,56h分别给予耳神门穴经皮电刺激30 min,对照组患者同时行经皮耳神门穴电刺激,但电极导线被断开,不产生电流刺激。2组患者诱导前均在超声引导下行患侧股神经置管,阻滞起效后实施全身麻醉,术后股神经阻滞导管接自控镇痛泵(锁定时间30min)持续镇痛72h。分别记录2组患者术后6,12,24,48,72h的疼痛目测类比评分和各时点股四头肌最大等长收缩肌力;记录自控镇痛用药的剂量和补救用药剂量;记录治疗后不良反应的发生率。结果与结论:①试验组在置换后48,72 h时运动目测类比评分小于对照组,差异有显著性意义(P<0.05);②对照组各时点的股四头肌最大等长收缩肌力均显著低于试验组,差异有显著性意义(P<0.05);③对照组股神经阻滞罗哌卡因的用量(495.7±39.4)mL明显多于试验组(394.5±27.1)mL,差异有显著性意义(P<0.05);对照组有7例患者术后注射盐酸曲马多,试验组有1例注射盐酸曲马多,差异有显著性意义(P<0.05);④对照组有6例发生恶心呕吐,试验组有1例发生恶心呕吐;对照组有4例头晕,试验组无头晕病例;差异有显著性意义(P<0.05);(5)术前采用经皮电刺激耳神门穴可以改善全膝关节置换术后疼痛,减少股神经阻滞局麻药物的应用剂量和术后补救药物的剂量,术后股四头肌肌力得到很好的保留。

BACKGROUND： Transcutaneous electrical acupoint stimulation （TEAS） exerts good analgesic effect, but its effectiveness and safety in analgesia after total knee arthroplasty have not been reported.OBJECTIVE： To evaluate the analgesic effect of TEAS at the auricular Shenmen （H 7） point in patients undergoing total knee arthroplasty.METHODS： Forty ASA Ⅰ-Ⅲ patients scheduled for total knee arthroplasty under general anesthesia combined with femoral nerve block were enrolled and randomly divided into experimental and control groups （n=20 per group）. The patients in the experimental group received TEAS at auricular Shenmen （H 7） point before anesthesia, 8, 16, 36, and 56 hours postoperatively for 30 minutes. The patients in the control group received same method with the experimental group, but without electrical stimulation. Ultrasound-guided continuous femoral nerve blockade was performed before induction, followed by tracheal tube was inserted and the patients were mechanically ventilated. The patients received patient-controlled continuous femoral nerve analgesia after surgery for 72 hours. The Visual Analogue Scale scores and the quadriceps maximum voluntary isometric contraction were recorded at postoperative 6, 12, 24, 48 and 72 hours. The consumption of ropivacaine and tramadol hydrochloride was recorded. Additionally, the incidence of adverse reactions was recorded.RESULTS AND CONCLUSION： （1） The Visual Analogue Scale scores in the experimental group were significantly lower than those in the control group at postoperative 48 and 72 hours （P 〈 0.05）. （2） The quadriceps maximum voluntary isometric contraction in the control group was significantly lower than that in the experimental group at each time point （P 〈 0.05）. （3） The consumption of ropivacaine in the control group （（495.7±39.4） mL） was significantly more than that in the experimental group （（394.5±27.1） mL） （P 〈 0.05）. Seven cases in the control group and one case in the experimental group received the injection of tramadol hydrochloride （P 〈 0.05）. （4） Nausea and vomiting occurred in six cases in the control group and one case in the experimental group, and dizziness only occurred in four cases in the control group （P 〈 0.05）. （5） To conclude, TEAS at the auricular Shenmen （H 7） point can improve the pain after total knee arthroplasty, reduce the consumption of ropivacaine and tramadol hydrochloride, and maintain quadriceps strength.