连续股神经阻滞对单髁关节置换术后早期恢复的影响

Effects of continuous nerve block on early recovery after unicompartmental knee arthroplasty

目的:评估连续股神经组滞(CFNB)相对于传统的病人自控静脉镇痛(PCIA),对单髁关节置换术(UKA)术后的镇痛效果及早期功能锻炼的影响。方法:选择宣武医院骨科收治的行UKA的膝关节骨关节炎患者40例,随机分为CFNB组和PCIA组,每组20例。记录并比较两组患者术后6、12、24 h的静息和活动疼痛评分、术后患肢关节活动情况和镇痛相关不良反应情况。结果:两组患者的一般资料无明显差异。CFNB组术后12 h静息痛和术后12、24 h活动疼痛评分低于PCIA组,差异具有统计学意义(P<0.05)。两组在术后首次直腿抬高时间、术前和术后膝关节活动度方面差异无统计学意义,但CFNB组首次主动屈膝时间优于PCIA组。在术后镇痛相关不良反应方面,CFNB组出现2例渗液,PCIA组出现4例恶心呕吐和1例皮肤瘙痒,两组不良反应发生率比较差异无统计学意义。结论:CFNB可以有效缓解患者术后疼痛,无明显不良反应,有利于患者术后早期进行功能锻炼。

Objective： To evaluate the effects of continuous femoral nerve block （CFNB）, comparing to traditional patient-controlled intravenous analgesia （PCIA）, on postoperative analgesia and early functional recovery after unicompartmental knee arthroplasty （UKA）. Methods： 40 patients admitted to Xuanwu Hospital with knee osteoarthritis who underwent UKA were randomly divided into CFNB group and PCIA group. The resting and active pain scores at 6, 12 and 24 h after operation were recorded and compared between the two groups. The postoperative joint activities and analgesia-related adverse reactions were recorded. Results： There was no significant difference between the two groups on baseline. The resting pain score at 12 h after operation and the activity pain score at 12, 24 h after operation in the CFNB group were lower than those in the PCIA group（ P 〈0. 05 ）. There was no significant difference between the two groups in the time of the first postoperative straight leg raising, the preoperative and postoperative range of motion, but the CFNB group was superior to the PCIA group in the first active knee flexion time. In the postoperative analgesia-related adverse reactions, 2 cases in the CFNB group exudate, 4 cases in the PCIA group complicated with nausea and vomiting and 1 case complicated with pruritus. There was no significant difference between the two groups. Conclusion： CFNB can effectively relieve postoperative pain in patients with no significant adverse reactions, which is conducive to early postoperative functional exercise.