全膝关节置换中鸡尾酒与股神经阻滞镇痛疗效早期对比:单中心随机双盲对照

Early analgesic effect of cocktail periarticular injection versus femoral nerve block in total knee arthroplasty:a single-center randomized double-blind control

背景:全膝关节置换中关节周围鸡尾酒注射镇痛模式的早期镇痛效果及患者满意度能否达到甚至超越股神经阻滞一直饱受争论。目的:比较全膝关节置换术中鸡尾酒镇痛与股神经阻滞镇痛的早期临床疗效。方法:选择2019年3至12月徐州医科大学附属医院收治的70例慢性膝关节骨性关节炎患者,采用计算机随机列表分为2组:观察组(n=35)接受全膝关节置换治疗,关闭切口前分别于关节囊后部及两侧副韧带区域、切口皮下组织注射鸡尾酒混合溶液,切口关闭后通过引流管注入鸡尾酒混合溶液;对照组(n=35)接受全膝关节置换治疗,关闭切口后注射麻醉药物进行股神经阻滞。术后14d内评估患者活动后的目测类比评分、膝关节主动活动度与患者镇痛满意度。试验获得徐州医科大学附属医院伦理委员会批准。结果与结论:①观察组术后2,3,5 d的目测类比评分低于对照组(P <0.05),其余时间点比较差异无显著性意义(P> 0.05);②观察组术后2,3 d的膝关节屈曲活动度大于对照组(P <0.05),其余时间点比较差异无显著性意义(P> 0.05);③观察中35例中23例对镇痛效果满意,对照组35例中10例对镇痛效果满意,组间比较差异有显著性意义(P <0.05);④观察组术后急性镇痛20次,对照组术后急性镇痛36次;⑤结果表明,膝关节置换中鸡尾酒关节腔内注射镇痛优于股神经阻滞镇痛,其术后早期可提高患者膝关节主动活动度与满意度,有利于术后患者膝关节早期康复。

BACKGROUND:It has been controversial whether the early analgesic effect and patient satisfaction of cocktail periarticular injection in total knee arthroplasty are better than femoral nerve block.OBJECTIVE:To compare the early clinical effect with cocktail periarticular injection and femoral nerve block in total knee arthroplasty.METHODS:From March to December 2019,70 cases with chronic knee osteoarthritis were collected from Affiliated Hospital of Xuzhou Medical University.The patients were randomly divided into two groups.In the observation group(n=35),patients received total knee arthroplasty.Cocktail solution was injected into the posterior capsule,bilateral collateral ligament areas,and the subcutaneous tissue of the incision.After the incision was closed,cocktail solution was injected into the drainage tube.In the control group(n=35),patients received total knee arthroplasty.The femoral nerve block was performed after the incision was closed.Postoperative visual analogue scale scores for pain,knee active activity and analgesic satisfaction of patients were assessed within 14 days after surgery.The study was approved by ethics committee of Affiliated Hospital of Xuzhou Medical University.RESULTS AND CONCLUSION:(1)At 2,3 and 5 days postoperatively,the visual analogue scale pain scores of the observation group were significantly lower than those of the control group(P<0.05);there was no significant difference at other time points(P>0.05).(2)The knee flexion of observation group was statistically greater than control group at 2 and 3 days postoperatively(P<0.05);there was no significant difference at other time points(P>0.05).(3)Totally 23 of 35 patients in the observation group were satisfied with the analgesic effect and 10 of the 35 patients in the control group were satisfied with the analgesic effect.The differences between the groups were significant(P<0.05).(4)Acute analgesia was observed 20 times in the observation group after operation,and 36 times in the control group.(5)The results showed that cocktail periarticular injection analgesia was superior to femoral nerve block analgesia in knee arthroplasty,which could improve the active motion and satisfaction of the knee in the early postoperative period.It was conducive to the early postoperative recovery of the knee.