单次股神经阻滞联合膝关节局部药物注射在全膝关节置换术后的镇痛作用

The analgesic effect of single-shot femoral nerve blockade combined with local drug injection on knee joint after total knee arthroplasty

目的探讨单次股神经阻滞联合膝关节局部药物注射在全膝关节置换术(Total Knee arthroplasty,TKA)后的镇痛作用。方法选取实行单侧全膝关节置换术患者30例,随机分为A、B、C三组,每组10例,三组患者术后的镇痛方式分别为:A组为单次股神经阻滞,B组为膝关节局部药物注射,C组为单次股神经阻滞联合膝关节局部药物注射。观察三组患者TKA后在静息及活动状态下不同时间点的疼痛视觉模拟评分(VAS),术后当晚及次晚因疼痛引起的睡眠中断次数,镇痛泵自控次数,术后因疼痛剧烈加用止痛药物的次数以及术后不良反应的发生情况。结果 C组在TKA后各不同时间点的静息、活动时的VAS评分均低于A、B两组;术后当晚及次晚因疼痛引起的睡眠中断次数C组少于A、B两组;镇痛泵的自控次数,C组低于A、B两组;三组患者在TKA后的不良反应发生情况上无明显统计学差异。A、B两组在各观察指标上没有明显差异。结论单次股神经阻滞联合膝关节局部药物注射对全膝关节置换术患者具有良好的术后镇痛作用。

Objective To discuss the analgesic effect of single-shot femoral nerve blockade combined with local drug injection on knee joint after total knee arthroplasty（TKA）.Methods 30 patients undergoing unilateral total knee arthroplasty（TKA）were collected and randomly divided into A,B,C three groups,each group of 10 cases.The postoperative analgesia methods of three groups are as follows：Group A was single-shot femoral nerve blockade;Group B was local drug injection in knee joint;Group C was single-shot femoral nerve blockade combined with local drug injection in knee joint.The VAS pain scores at different times in the three groups of paints after TKA in the static and active state,the numbers of sleep interruption caused by pain in the evening and later night of the postoperative,the number of using PCA（patient control analgesia）,the utilization rate of postoperative analgesic drugs and the incidence of postoperative adverse reactions were Observed.Results The VAS scores of group C at different time points after TKA in the static and active state was lower than that of group A and B.The number of sleep interruptions caused by pain in the evening and later night of the postoperative of group C was lower than that of group A and B.The numbers of using PCA（patient control analgesia）and the utilization rate of postoperative analgesic drugs of group C were lower than that of group A and B.There was no significant difference of the incidence of postoperative adverse reactions in the three groups.There was no significant difference on each observation index between group A and B.Conclusion The method of single-shot femoral nerve blockade combined with local drug injection in knee joint had good postoperative analgesic effect on patients with TKA.