关节周围注射罗哌卡因混合液联合股神经阻滞用于膝关节置换术后镇痛

Periarticular Injection of Ropivacaine Mixture Combined with Femoral Nerve Block on Postoperative Analgesia after Total Knee Arthroplasty

目的:比较连续股神经阻滞联合关节周围注射罗哌卡因混合液与单纯连续股神经阻滞对全膝关节置换(TKA)术后疼痛的影响。方法:选择ASA Ⅰ~Ⅱ级择期在腰硬联合麻醉下行TKA的患者60例,随机分为连续股神经阻滞联合关节周围注射罗哌卡因混合液组(A组)和连续股神经阻滞组(B组)各30例,观察和比较两组术后静息及被动运动时视觉模拟评分(VAS)、肌力分级、患者镇痛满意度、补救镇痛情况、不良反应及术后下肢深静脉血栓形成情况。结果:A组术后8、12、24 h静息VAS评分分别为(1.33±0.49)、(1.40±0.51)、(1.13±0.64),术后4、8、12、24 h运动VAS评分分别为(1.73±0.46)、(1.67±0.48)、(1.93±0.46)、(1.53±0.64),均明显低于B组(P<0.05或0.01)。两组肌力均良好,无统计学差异。A组镇痛满意度评分高于B组(P<0.05),其中"非常好+很好"占66.7%,B组占40%。两组不良反应发生率、补救镇痛和术后深静脉血栓发生情况差异无统计学意义。结论:连续股神经阻滞联合关节周围注射罗哌卡因混合液法较单纯连续股神经阻滞可更加有效降低全膝关节置换术后的疼痛评分,且病人满意度高。

Objective To compare the effect of continuous femoral nerve block combined with periarticular injection of ropivacaine mixture on postoperative analgesia after total knee arthroplasty(TKA).Methods Sixty ASA I-II patients undergoing unilateral TKA under combined spinal anesthesia were selected.They were randomly divided into two groups(n=30).Patients in group A received a continuous femoral nerve block combined with periarticular injection.Patients in group B were given a continuous femoral nerve block.Visual analogue scores(VAS)during rest and movement,muscle strength grades,satisfaction of analgesia,remedial analgesia,adverse reaction and postoperative deep venous thrombosis of lower extremity were observed and recorded.Results The VAS during rest at postoperative 8,12 and 24 h in group A were 1.33±0.49,1.40±0.51 and 1.13±0.64,and the VAS during movement at 4,8,12 and 24 h were 1.73±0.46,1.67±0.48,1.93±0.46 and 1.53±0.64,which were all obvious lower than those in group B(P<0.05 or 0.01).The level of patient satisfaction in group A was 66.7%,much higher than that in group B,which was 40%(P<0.05).There was no significant difference in muscle strength grades and incidence of side effects.Conclusion A femoral nerve block combined with periarticular injection could attenuate pain more effectively,with a higher level of patient satisfaction.