持续收肌管阻滞术后镇痛在全膝关节置换术快速康复中的作用

The effect of continuous adductor canal block on enhanced recovery after surgery in primary total knee arthroplasty

目的探讨持续收肌管阻滞(CACB)术后镇痛在全膝关节置换术(TKA)快速康复中的作用,以进一步优化TKA术后的快速康复方案。方法将90例行单侧TKA的患者按随机数字表法分为CACB组与持续股神经阻滞(CFNB)组,每组45例。所有患者纳入快速康复模式。CACB组手术结束20 min由麻醉医师行术侧收肌管阻滞并留置导管,CFNB组手术结束20 min行术侧股神经阻滞并留置导管。比较两组住院时间、术后静息和活动疼痛数字评分法(NRS)评分、股四头肌肌力、膝关节活动度、膝关节HSS评分、补救性阿片类药物的消耗、术后并发症。结果住院时间CFNB组为(13.2±2.98) d,长于CACB组的(11.9±2.59) d(P <0.05);除术后12 h活动NRS评分CACB组高于CFNB组(P <0.05),两组术后不同时点静息NRS评分和活动NRS评分差异无统计学意义(P> 0.05);CACB组术后第1、2、3、7天膝关节活动度、膝关节HSS评分均高于CFNB组(P <0.05),CACB组术后1、2、3 d股四头肌肌力均高于CFNB组(P <0.05)。结论 CACB术后镇痛在TKA中应用能保留股四头肌肌力,缩短住院时间,更有利于快速康复模式的实施。

Objective To explore the influence of continuous adductor canal block( CACB) strategy on enhanced recovery after surgery in primary total knee arthroplasty( TKA).Methods Ninety cases who received primary unilateral TKA were enrolled in this study.The patients were randomly divided into the CACB group and the continuous femoral nerve block( CFNB) group,45 cases each group.All patients were involved in the mode of enhanced recovery after surgery.The CACB group was given adductor canal block at 20 min after the surgery.The CFNB group was given femoral nerve block at 20 min after the surgery.The hospital stay,the resting and motion numeric rating scales( NRS)scores,the muscle strength of quadriceps femoris,the knee joint range of motion,HSS score,total opioid consumption and complications were observed and compared between two groups.Results In CACB group,the discharge time was( 11.9 ± 2.59) d,significantly shorter compared with( 13.2 ± 2.98) d in CFNB group( P < 0.05).Except the motion NRS of postoperative 12 h in the CACB group was higher than the CFNB group( P < 0.05),there were no significant differences in the resting and motion NRS scores between the two groups( P > 0.05).The range of motion( 1,2,3,7 d after surgery) and HSS scorein the CACB group were higher than in the CFNB group( P < 0.05),the muscular strength of quadriceps femoris( 1,2,3 d after surgery) in the CACB group was higher than in the CFNB group( P <0.05).Conclusions CACB strategy can provide superior quadriceps strength,a faster time to discharge,which may be benefit to the implement of enhanced recovery after surgery in TKA.