间断给药收肌管阻滞用于全膝关节置换术后的镇痛效果

Analgestic efficacy of intermittent boluses for adductor canal block after total knee arthroplasty

目的比较超声引导下连续收肌管阻滞(continuous adductor canal block,CACB)的两种给药方式对全膝关节置换术(total knee arthroplasty,TKA)后镇痛效果及早期活动的影响。方法接受蛛网膜下腔麻醉下行单侧全膝关节置换术的患者67例,男13例,女54例,年龄18～85岁,BMI 18～30kg/m^2,ASAⅠ～Ⅲ级,按随机数字表法分为恒速输注给药组(A组,n=34)和间断给药组(B组,n=33)。术毕行超声引导下CACB,负荷剂量0.2%罗哌卡因20ml。两组均连接电子输注泵行术后镇痛,镇痛泵配方为0.2%罗哌卡因240ml。A组恒速输注5 ml/h;B组自动给药每次5ml,间隔时间60min。两组单次按压剂量5ml,锁定时间30min,持续输注48h。记录术后不同时点镇痛泵用药总量、地佐辛使用量、股四头肌肌力、膝关节屈曲角度和步行距离以及恶心呕吐、头晕、嗜睡、置管处渗血渗液等不良反应的发生情况。结果 B组术后12、24h镇痛泵用药总量明显少于A组(P<0.05),术后48h地佐辛使用量明显少于A组(P<0.05);B组术后24、48h膝关节屈曲角度明显大于A组(P<0.05),术后48、72h步行距离明显长于A组(P<0.05)。两组股四头肌肌力差异无统计学意义。A组恶心呕吐发生率明显高于B组(P<0.05);两组其他不良反应发生率差异无统计学意义。结论 CACB用于TKA术后镇痛,与恒速输注给药方式比较,间断给药的输注方式可以提供更好的镇痛效果,减少术后阿片类镇痛药的使用,同时不增加对运动神经的阻滞作用,有利于患者术后早期活动。

Ojective To compare two different regimens of ultrasound-guided Continuous adductor canal block （CACB） for postoperative analgesia and early ambulation after total knee arthroplasty （TKA）. Methods Sixty-seven patients scheduled for unilateral TKA undergoing spinal anesthesia, 13 males and 54 females, aged 18-85 years, BMI 18-30 kg/m2, ASA physical status Ⅰ-Ⅲ, were randomly divided into the continuous infusion group A （n=34） and the intermittent boluses group B （n=33）. After the operations, ultrasound-guided CACB were administered and 20 ml of 0.2% ropivacaine was given as the loading dose. From then on, patients in both groups used electronic analgesic pumps containing 240 ml of 0.2% ropivacaine for postoperative analgesia. 5 ml/h of 0.2% ropivacaine was continuously infused for 48 hours in the group A. 5 ml of 0.2% ropivacaine was automated injected every 60 minutes in the group B. All infusion pumps were setted at a bolus dose of 5 ml, with a lock time of 30 minutes. The total consumptions of analgestic pum solution and dezoine, quadriceps muscle strength, active range of knee flexion, ambulation distance and occurrences of adverse reactions such as nausea and vomiting, dizziness, drowsiness, extravasating and errhysis were recorded at different time points postoperatively. Results The total consumptions of analgestic pum solution at 12, 24 h postoperatively of group B were significantly reduced than that of group A （P〈0.05）. The 48 h total dezoine consumption of group B was significantly reduced than group A （P〈0.05）. Active range of knee flexion at 24, 48 h and ambulation distance at 48, 72 h of group B were significantly higher than group A （P〈0.05）. There was no statistical difference in quadriceps muscle strength between group A and group B. The incidence of nausea and vomiting in group A was significantly higher than that in group B, and there were no statistical difference in other adverse reactions between group A and group B. Conclusion Compared with the continuous infusion group, the intermittent bolus group for CACB after TKA can provide better analgesic effect and decrease opioid use postoperatively, with little effect on motor nerve, promoting early ambulation.