超声引导下股神经阻滞复合全身麻醉对老年膝骨关节炎患者术后疼痛程度及苏醒时间的影响

Effect of ultrasound-guided femoral nerve block under general anesthesia on postoperative pain and recovery time in elderly patients with knee osteoarthritis

目的研究超声引导下股神经阻滞复合全身麻醉对老年膝骨关节炎(KOA)患者术后疼痛程度及苏醒时间的影响。方法选取我院老年KOA患者94例,随机数字表法分为对照组(47例)和研究组(47例)。2组均行膝关节置换术治疗,对照组施行气管插管静吸复合全身麻醉,研究组采用超声引导下股神经阻滞复合全身麻醉。对比2组麻醉起效时间、丙泊酚用量、术后苏醒时间、拔管时间、术后1 h疼痛程度[视觉模拟评分(VAS)]、围手术期[喉罩置入/气管插管时(T0)、切皮即刻(T1)、假体植入时(T2)、缝合时(T3)、入麻醉苏醒室后15 min(T4)]、围手术期血流动力学指标[平均动脉压(MAP)、心率(HR)]及不良反应发生率。结果研究组麻醉起效、术后苏醒及拔管等时间均短于对照组,丙泊酚用量少于对照组,术后1 h VAS评分低于对照组(P<0.05);T0时段,2组HR、MAP水平差异无统计学意义(P>0.05);T1、T2、T3及T4时段,研究组HR、MAP水平低于对照组(P<0.05);研究组不良反应总发生率[4%(2/47)]低于对照组[17%(8/47)](P<0.05)。结论超声引导下股神经阻滞复合全身麻醉能明显减少老年KOA患者膝关节置换术中麻醉药物用量,改善麻醉效果,缩短术后苏醒时间,减轻术后疼痛程度,且能更好维持围手术期血流动力学稳定,降低不良反应发生率。

Objective To investigate the effect of ultrasound-guided femoral nerve block under general anesthesia on postoperative pain and recovery time in elderly patients with knee osteoarthritis(KOA).Methods Ninety-four elderly patients with KOA admitted to our hospital were included in the study and randomly divided into the control group and study group(n=47 each).Both groups underwent knee arthroplasty.The control group underwent endotracheal intubation under general anesthesia.The study group underwent ultrasound-guided femoral nerve block under general anesthesia.The onset time of anesthesia,dose of propofol,recovery time after surgery,extubation time,degree of pain at 1 h after surgery(VAS score),hemodynamic parameters[mean arterial pressure(MAP)and heart rate(HR)]and incidence of adverse reactions during perioperative period[time at throat mask placement/tracheal intubation(T0),immediate incision(T1),prosthesis implantation(T2),suture(T3),and 15 min after entering anesthesia recovery room(T4)]were compared between the two groups.Results The anesthesia effect,and time of postoperative recovery and extubation in the study group were shorter than those in the control group.The dose of propofol in the study group was lower than that in the control group.The VAS score in the study group was lower than that in the control group at 1 h after operation(all P<0.05).There were no statistically significant differences in the levels of HR and MAP at T0 between the two groups(both P>0.05).The levels of HR and MAP in the study group were lower than those in the control group at T1,T2,T3 and T4(all P<0.05).The total incidence of adverse reactions in the study group was lower than that in the control group[4%(2/47)vs 17%(8/47),P<0.05].Conclusion Ultrasound-guided femoral nerve block under general anesthesia may significantly reduce the dose of anesthetic drugs in knee arthroplasty in elderly patients with KOA,improve anesthetic effect,shorten postoperative recovery time,decrease postoperative pain,better maintain hemodynamic stability during perioperative period,and reduce incidence of adverse reactions.