超声引导收肌管阻滞联合关节周围浸润对小儿膝关节术后的镇痛效果

Effects of ultrasound guided continuous adductor canal block combined with periarticular local infiltration analgesia in the postoperative analgesia of children undergoing knee arthroplasty

目的探讨超声引导收肌管阻滞(CACB)联合关节周围浸润镇痛(PLIA)对小儿膝关节术后的镇痛效果。方法选取2016年2月～2018年3月我院骨科收治的78例单侧膝关节手术患儿为研究对象,根据不同麻醉方案分为观察组(n=38)和对照组(n=40),观察组采用超声引导收肌管阻滞联合关节周围浸润镇痛,对照组采用单纯超声引导收肌管阻滞镇痛。采用视觉疼痛模拟评分(VAS)评价两组术后的疼痛程度,并观察记录术后镇痛的满意度及股四头肌肌力减弱情况,比较两组术后膝关节活动度及术后并发症等情况。结果观察组镇痛满意度在术后6h、12h、24h明显高于对照组,差异有统计学意义(P<0.05);观察组股四头肌肌力减弱发生率在术后4h、6h、12h显著低于对照组,差异亦有统计学意义(P<0.05)。观察组VAS评分在术后24h明显低于对照组(P<0.05),但在术后4h、6h、12h,两组VAS评分无明显差异(P>0.05)。观察组直腿抬高时间、被动屈膝90°角时间均显著低于对照组(P<0.05);两组并发症总发生率比较,观察组(5.3%)显著低于对照组(22.5%),差异亦有统计学意义(P<0.05)。结论超声引导收肌管阻滞联合关节周围浸润镇痛用于小儿膝关节术后镇痛临床效果明显,有利于膝关节活动度,缩短预后时间,促进预后,可在临床上推广使用。

Objective To investigate the effects of ultrasound guided continuous adductor canal block (CACB) combined with periarticular local infiltration analgesia (PLIA) in the postoperative analgesia of children undergoing knee arthroplasty. Methods 78 patients undergoing unilateral knee arthroplasty in orthopedics department of our hospital from February 2016 to March 2018 were selected and divided into two groups according to the different anesthesia regimens. The observation group (n=38) received the ultrasound guided CACB combined with PLIA, while the control group (n=40) just received the ultrasound guided CACB. Then the pain degree assessed by the visual analogue scale (VAS), postoperative analgesia satisfaction, quadriceps strength, mobility of knee join and complications were observed in both groups. Results The analgesic satisfaction of the observation group was significantly higher than that of the control group at postoperative 6h, 12h and 24h (P<0.05). The incidence rate of the quadriceps weakness of the observation group was significantly lower than that of the control group at postoperative 4h, 6h and 12h (P<0.05). The VAS score of the observation group was significantly lower than that of the control group at postoperative 24h (P<0.05), while no difference was found at postoperative 4h, 6h, and 12h (P>0.05). The time of active straight-leg raising and passive flexing knees to 90° in the observation group was shorter than that of the control group (P<0.05). The overall incidence of complications in the observation group was significantly lower than that in the control group (5.3% vs 22.5%, P<0.05). Conclusion The application of ultrasound guided CACB combined with PLIA can significantly reduce the VAS score, ameliorate the knee joint mobility, shorten the prognosis time and promote the outcomes for patients undergoing unilateral knee arthroplasty, which is worthy of promotion.