0.18%罗哌卡因连续股神经阻滞用于膝关节置换术后镇痛评价

Evaluation of CFNB with 0.18% Ropivacaine on Postoperative Analgesiain Total Knee Arthroplasty

目的:观察0.18%罗哌卡因连续股神经阻滞用于膝关节置换术后镇痛效果。方法:选择行单侧全膝关节置换术患者60例,采用随机数字表法分为两组,各30例,两组麻醉均采用腰-硬联合麻醉。术后镇痛N组:B超联合神经刺激仪引导连续股神经阻滞镇痛(CFNB),E组:连续硬膜外镇痛(PCEA)。比较两组术后6h(T0)、12h(T1)、24h(T2)、48h(T3)静息及运动状态疼痛视觉模拟评分(VAS)、各时间点患肢肌力及患者总体镇痛满意度。结果:术后各时点静息状态VAS评分差异无统计学意义;运动状态下,T0、T1、T3时间点VAS评分N组低于E组,T2时间点N组高于E组,但差异均无统计学意义。两组各时点VAS评分均小于4分;各时点患肢肌力N组均高于E组,且T0、T1、T2时间点组间差异有统计学意义(P<0.05);N组患者总体镇痛满意度(28例,93.3%)明显高于E组(23例,76.7%),但两组间差异无统计学意义。结论:采用0.18%罗哌卡因CFNB用于全膝关节置换术术后超过48小时镇痛效果确切,有利于早期功能锻炼,患者满意度高,是一种较为理想的术后镇痛方法。

Objective:To observe the analgesic effects of continuous femoral nerve block with 0.18%ropivacaine in total knee arthroplasty(TKA).Methods:Sixty patients with unilateral total knee arthroplasty undergoing combined spinal-epidural anesthesia were selected and randomly divided into two groups with 30 cases respectively.Group N(postoperative analgesia)underwent continuous femoral nerve block analgesia guided by B-ultrasound combined with nerve stimulator(CFNB),and group E continuous epidural analgesia(PCEA).The effects of rest and exercise state analgesia(VAS score),and the muscle strength of affected limbs,and the overall analgesic satisfaction between the two groups after operation were compared at 6h(T0),12 h(T1),24h(T2),48h(T3).Results:There was no significant difference in VAS score of resting state at each time point after operation.Under the condition of exercise,VAS score at T0,T1,T3 time point in group N was lower than that in group E,and it was higher in group N than that in group E at T2 time point,but there was no significant difference between the two groups.VAS score was less than 4 points at each time point in the two groups.The muscle strength of the affected limb in group N was higher than that in group E at each time point,and there was significant difference in T0,T1 and T2 time points between two groups(P<0.05).The total analgesic satisfaction of group N(28 cases,93.3%)was higher than that of group E(23 cases,76.6%),but there was no significant difference between two groups.Conclusion:The strategy of CFNB with 0.18%ropivacaine on analgesia in more than 48 hours after total knee arthroplasty was clear in its effects,beneficial to early functional exercise,highly satisfactory in patients,and an ideal postoperative analgesia method.