超声引导下持续收肌管阻滞与髂筋膜阻滞对膝关节置换术后镇痛的影响

Comparison of Postoperative Analgesia between Ultrasound Guided Adductor Canal Block and Fascia Iliac Compartment Block in Patients afer Total Knee Arthroplasty

目的比较超声引导下收肌管阻滞(ACB)与髂筋膜阻滞(FICB)对膝关节置换术后镇痛的影响。方法选取2018年6—12月在单县中心医院行单侧膝关节置换术患者68例,年龄45~78岁,体重59~98kg,性别不限,ASA在Ⅰ~Ⅱ级。采用随机数字表法,将患者分为两组:收肌管阻滞组(Ⅰ组)和髂筋膜阻滞组(Ⅱ组),在全麻诱导后,两组患者分别接受超声引导下ACB和FICB,记录两组患者术后阿片类药物使用量,术后静息和活动时的疼痛评分,术后膝关节活动度,术后并发症发生率等。结果Ⅰ、Ⅱ组患者术后阿片类药物使用量(104±43)ugvs(126±51)ug,两组之间差异无统计学意义(P>0.05);术患者首次直腿抬高时间Ⅰ组均短于Ⅱ组(130.9±31.0)minvs(699.1±65.0)min(t=-46.1,P<0.05)。结论对于膝关节置换患者,超声引导下收肌管阻滞与髂筋膜阻滞镇痛效果相当,对股四头肌肌力影响更小,更利于患者进行早期关节功能的锻炼。

Objective To compare postoperative analgesia between ultrasound guided adductor canal block (ACB) and fascia iliac compartment block (FICB) in patients after total knee arthroplasty. Methods A total of 68 patients with unilateral knee arthroplasty from June 2018 to December 2018 admitted to the county hospital were selected. They were 45-78 years old, weighing 59-98 kg, without gender limitation, and their ASA was at I-II level. They were randomly divided into 2 groups: ACB group (group Ⅰ) and FICB group (group Ⅱ). After induction of general anesthesia, the two groups underwent ultrasound-guided ACB and FICB. The postoperative opioid use, postoperative resting and active pain scores, postoperative knee mobility, and postoperative complication rate were recorded. Results No differences were found between the two groups postoperative opioid use after operation. knee joint Patients of group Ⅰ were superior to those of group Ⅱ in motor function recovery. Activity of knee was higher in patients of group Ⅰ(130.9±31.0)min than that in group Ⅱ postoperatively(699.1±65.0)min(t=-46.1,P<0.05). Conclusion ACB and FICB have equal postoperative analgesic effect for TKA patients. But ACB has less influence on the force of quadriceps femoris than FICB. Therefore, patients of ACB group are superior to those of FICB group in motor function recovery, showing better activity of knee and early time of first straight leg raising.