收肌管阻滞与局部浸润镇痛对全膝关节置换术后患者早期镇痛效果的临床研究

The effect of adductor canal block and local infiltration analgesia for postoperative analgesia after total knee arthroplasty

目的观察多模式镇痛下收肌管阻滞(adductor canal block, ACB)与局部浸润镇痛(local infiltration analgesia, LIA)对全膝关节置换术(total knee arthroplasty, TKA)后镇痛及早期康复的影响。方法选择2017年6~12月解放军总医院第一医学中心行单侧TKA患者80例,采用随机数字表法分为ACB组[ACB联合持续静脉患者自控镇痛(patient controlled analgesia, PCA)]和LIA组(关节周围局部浸润联合静脉PCA),每组40例。于术后4 h、8 h、12 h、24 h、48 h观察患者静息及运动时VAS评分、股四头肌肌力;记录患者术后首次下地行走时间,住院时间,术后24 h、48 h主、被动屈膝角度以及术后48 h血清CRP及IL-6水平,术后不良反应以及术后24 h内补救镇痛药物地佐辛的使用量。结果术后12h、24 h,ACB组运动VAS评分低于LIA组(P <0.05);术后24 h,ACB组主、被动屈膝角度大于LIA组(P <0.05),下床时间早于LIA组(P <0.05),术后补救镇痛药物地佐辛的使用率也低于LIA组(P <0.05);患者术后不良反应发生率组间比较差异无统计学意义(P> 0.05)。结论 ACB对TKA术后动态的镇痛效果优于LIA组,降低了地佐辛的使用量,促进患者早期下床进行功能康复训练。

Objective To compare the analgesic effect and early rehabilitation between adductor canal block(ACB and local infiltration analgesia(LIA) after initial total knee arthroplasty(TKA).Methods Eighty patients undergoing initial TKA from June to December 2017 in The First Medical Center of Chinese PLA General Hospital were randomly divided into two groups, and received ultrasound-guided ACB(group ACB, n=40) or local infiltration analgesia(group LIA, n=40) respectively. VAS scores at rest and during movement at 4, 8, 12, 24 and 48 h after surgery, maximal flexion of the knee at 24 h and48 h after surgery, the quadriceps strength, hospitalization time, the amount of remedial analgesics and complications were recorded, as well as CRP and IL-6 level. Results VAS scores were comparable at rest(P > 0.05), but significant differences were shown in movement at 12 h and 24 h postoperation between two groups(P < 0.05). Maximal flexion of the knee in active and passive movement were remarkably significant at 24 h postoperation(P < 0.05). The numbers of days for walking with assisted ambulation and opioid consumption in ACB group were superior to LIA group(P < 0.05). There was no difference in side effect of nausea and vomiting between two groups. Conclusions ACB in multimodal anesthesia following TKA can significantly benefit on early rehabilitation, and reduce the requirements for analgesics, with no apparent risks.