罗哌卡因复合右美托咪定连续收肌管阻滞对促进膝关节置换快速康复的影响

Effects of continuous adductor canal block of dexmedetomidine combined with ropivacaine on rapid postoperative rehabilitation of patients after total knee arthroplasty

目的观察罗哌卡因复合右美托咪定用于连续收肌管阻滞(adductor canal block,ACB)镇痛对膝关节置换术(total knee arthroplasty,TKA)快速康复的影响。方法选取接受单侧全膝关节置换术患者60例,ASA分级Ⅰ~Ⅲ级,性别不限,按照随机数字表法随机分为A组和B组,每组30例,患者麻醉方式均为全身麻醉,术后采用ACB方式进行镇痛,A组为0.2%罗哌卡因持续术后镇痛,B组为0.2%罗哌卡因+1.0μg/ml右美托咪定。比较2组VAS评分、Ramsay评分、膝关节主动屈曲角度、镇痛泵追加次数、术后双氯芬酸钠使用情况、不良反应。结果术后8、12、24、48 h时,B组静息疼痛评分和运动疼痛评分均低于A组(P<0.05);B组镇静评分均高于A组(P<0.05);B组膝关节主动屈曲角度均大于A组(P<0.05)。B组术后48 h内镇痛泵追加次数明显少于A组(P<0.05),B组术后双氯芬酸钠使用起始时间晚于A组(P<0.05),B组双氯芬酸钠用量也少于A组(P<0.05)。2组药物不良反应发生率差异无统计学意义(P>0.05)。结论在膝关节置换术后超声引导下ACB时,选择罗哌卡因复合右美托咪定可有效缓解患者疼痛,维持其镇静状态,促使患者膝关节活动度有效改善,且不良反应较少,安全可靠。

Objective To investigate the effects of continuous adductor canal block(CACB)of dexmedetomidine combined with ropivacaine on rapid postoperative rehabilitation of patients after total knee arthroplasty(TKA).Methods Sixty patients who underwent unilateral TKA under general anesthesia,with both males and females,ASAⅠ~Ⅲ,were randomly divided into two groups,with 30 cases in each group.All the patients received general anaesthesia during surgery,then given postoperative analgesia with CACB.The patients in group A were given postoperative analgesia with 0.2%ropivacaine,however,the patients in group B were given postoperative analgesia with 0.2%ropivacaine+1.0μg/ml dexmedetomidine.The scores of VAS and Ramsay,the active knee flexion angles,the number of increment of drugs,postoperative usage of diclofenac sodium and adverse reactions were observed and compared between the two groups.Results The VAS scores at rest and during activity at 8h,12h,24h,48 h after operation in group B were significantly lower than those in group A(P<0.05),however,the Ramsay scores were significantly higher than those in group A(P<0.05).The active knee flexion angle in group B was significantly greater than that in group A(P<0.05),however,the number of increment of drugs in group B was significantly less than that in group A(P<0.05).Moreover the onset time of postoperative use of diclofenac sodium in group B was significantly later than that in group A(P<0.05),and the usage amount of diclofenac sodium in group B was significantly less than that in group A(P<0.05).In addition no severe adverse reactions were found in both groups.Conclusion The continuous adductor canal block with dexmedetomidine and ropivacaine can improve the rapid postoperative rehabilitation of patients after total knee arthroplasty,which is safe and relaible,with fewer adverse reactions.