连续隐神经阻滞复合舒芬太尼在膝关节镜术后镇痛中的应用研究

A randomized controlled study of continuous saphenous nerve block with sufentanil used for postoperative analgesia after knee arthroscopic surgery

目的:观察连续隐神经阻滞复合舒芬太尼用于膝关节镜手术患者的术后镇痛效果。方法:择期行单侧膝关节镜手术患者80例,采用相同的麻醉方式和手术方案,术后均行连续神经阻滞自控镇痛48h,持续剂量2ml,总量100ml/h,随机分为四组:单纯0.225%罗哌卡因行股神经阻滞组(F组),0.15%罗哌卡因复合1μg/ml舒芬太尼行股神经阻滞组(FD),单纯0.225%罗哌卡因行隐神经阻滞组(S组)和0.15%罗哌卡因复合1μg/ml舒芬太尼行隐神经阻滞组(SD组)。记录四组患者术前、术后24、48、72h和7d静息状态下疼痛评分(RVAS)和活动状态下疼痛评分(AVAS)。记录四组患者术后12、24、36、48h的股四头肌肌力情况。结果:术后四组患者各时间点静息状态下VAS评分以及术后24、48h和7d活动状态下VAS评分明显低于术前(P<0.05)。术后3d股神经复合舒芬太尼组(FD组)、隐神经复合舒芬太尼组(SD组)AVAS评分高于股神经阻滞组(F组)和隐神经阻滞组(S组)。SD组和S组术后24、36、48h股四头肌肌力高于FD组和F组。结论:连续隐神经阻滞用于膝关节镜手术,可提供良好的术后镇痛效果,与连续股神经阻滞(FNB)相比,对股四头肌肌力影响小,但较低浓度罗哌卡因(0.15%)复合舒芬太尼不及较高浓度(0.225%)罗哌卡因镇痛维持时间长。

Objective:To explore the efficacy of continuous saphenous nerve block(SNB)with sufentail used for postoperative analgesia after knee arthroscopic surgery.Methods:Eighty patients underwent selective knee arthroscopic surgery,received postperative analgesia wit continuous nerve block for 48 hours,continuous dose 2 ml/h,totle dose 100 ml,then were randomly divided into four groups:femoral nerve block group with 0.225%ropivacaine(group F);femoral nerve block group with 0.15%ropivacaine mixed sufentanil 1μg/ml(groupFD);saphenous nerve block group with 0.225%ropivacaine(group S);saphenous nerve block group with 0.15%ropivacaine mixed sufentanil 1ug/ml(group SD).The visual analogue scale(VAS)in resting state(RVAS),active functional exercise state(AVAS)were recorded at pre-operation and 24,48,72 h,7 d after surgery.The quadriceps muscle strength was recorded at 12,24,36,48 h after surgery.Results:Compared with preoperative situation,the pain scores at rest in each group were significantly decreased on every time after surgery,the AVAS scores were sigificantly lower at 24h,48h,7d after surgery(P<0.05).Compared with group F and group D,the RVAS scores were significantly higher either in group FD and group SD at the 3d postoperativly(P<0.05).the quadriceps muscle strength at 24,36,48 h in the group S and group SD was higher than that in the group F and group FD.Conclusion:Both SNB and FNB can offer effective analgesic results after knee arthroscopic surgery,but SNB has less influence on quadriceps muscle strength than FNB.Compared to 0.225%ropivacaine,0.15%ropivacaine mixed 1μg/ml sufentanil may not keep a longer anlgesia duration.