收肌管阻滞与股神经阻滞在全膝关节置换术后镇痛的效果分析

Analgesic effects of adductor canal block and femoral nerve block after total knee arthroplasty

目的探讨收肌管阻滞与股神经阻滞在全膝关节置换术后镇痛的效果。方法分析海军军医大学附属长海医院2016年2～10月关节骨病外科收治的80例全膝关节置换术患者临床资料,依据麻醉方式不同进行分组,收肌管阻滞组40例和股神经阻滞组40例。观察两组全膝关节置换术患者在术后不同时间点静息痛数字评分量表(NRS)、活动痛NRS、股四头肌肌力情况,观察两组全膝关节置换术患者术后不同时间点膝关节活动度情况。结果两组全膝关节置换术患者在术后不同时间点静息痛NRS评分、活动痛NRS评分比较,差异均无统计学意义(P> 0.05)。收肌管阻滞组患者在术后2、4、8、12、24、48 h股四头肌肌力分级高于股神经阻滞组,两组患者随着时间延长静息痛NRS评分、活动痛NRS评分逐步降低,差异均有统计学意义(P <0.05),两组患者在术后72 h股四头肌肌力分级比较,差异无统计学意义(P> 0.05),两组患者随着时间延长股四头肌肌力分级逐步升高,差异均有统计学意义(P <0.05),收肌管阻滞组全膝关节置换术患者术后24、48、72 h膝关节活动度均高于股神经阻滞组,差异均有统计学意义(P <0.05)。结论收肌管阻滞与股神经阻滞在全膝关节置换术后镇痛效果相当,但是收肌管阻滞患者在术后股四头肌肌力分级、膝关节活动度均优于股神经阻滞。

Objective To investigate the analgesic effect of adductor canal block and femoral nerve block after total knee arthroplasty. Methods To analyze the clinical data of 80 total knee replacement patients admitted to Changhai Hospital, Naval Medical University from February 2016 to October 2016, there were 40 patients in adductor duct block group and 40 patients in femoral nerve block group. The rest pain digital score scale (NRS), active pain NRS and quadriceps femoris muscle strength of the two groups of total knee arthroplasty patients at different time points after surgery were observed, and the knee range of motion of total knee arthroplasty patients of the two groups at different time points after surgery were observed. Results There was no significant difference in NRS score of resting pain and NRS score of active pain between the two groups at different time points after total knee replacement (P > 0.05). The muscle strength grades of quadriceps femoris in the adductor duct block group were higher than that in the femoral nerve block group at 2, 4, 8, 12, 24 and 48 h after surgery. The NRS score of resting pain and NRS score of active pain in the two groups decreased gradually with time extension, and the differences were statistically significant (P < 0.05). There was no statistically significant difference in quadriceps femoris muscle strength grading between the two groups 72 h after surgery (P > 0.05). The quadriceps femoris muscle strength grading increased gradually with the extension of time in both groups, and the difference was statistically significant (P < 0.05). The ranges of motion of the knee joint in the adductor duct group 24, 48 and 72 h after surgery were higher than those in the femoral nerve block group, and the differences were statistically significant (P < 0.05). Conclusion Adductor canal block and femoral nerve block have the same analgesic effect after total knee arthroplasty, but adductor canal block patients are superior to femoral nerve block in postoperative muscle strength grade of quadriceps femoris and range of motion of knee joint.