全膝关节置换过程中鸡尾酒疗法联合股神经阻滞的镇痛效果

Analgesic effect of cocktail therapy combined with femoral nerve block on total knee arthroplasty

背景:全膝关节置换是挽救膝关节功能的重要措施,但术后疼痛给患者造成极大痛苦。多模式镇痛背景下,鸡尾酒疗法、股神经阻滞被广泛用于临床,镇痛效果确切;但是两种方法同时使用的镇痛效果及安全性不明,因此需要更多的临床证据。目的:观察鸡尾酒疗法联合股神经阻滞对全膝关节置换后镇痛、功能恢复的影响及安全性,为临床提供参考。方法:纳入100例初次单侧全膝关节置换患者,按照随机数字表分成2组(n=50),A组为鸡尾酒疗法联合股神经阻滞镇痛组,B组为等量生理盐水+股神经阻滞镇痛组。比较两组患者术后静息状态下目测类比评分、膝关节活动度、整体疼痛评分及不良反应发生情况,并记录镇痛药物使用时间及频次。结果与结论:①在术后24,36,48 h,A组的目测类比评分均低于B组(P<0.05);而在术后12,72 h两组差异无显著性意义(P>0.05);②在术后第1,3天,A组的膝关节活动度高于B组(P<0.05);术后第14天、1个月、3个月,两组差异无显著性意义(P>0.05);③术后3个月,两组的整体疼痛评分差异无显著性意义(P>0.05);④在不良反应及追加镇痛药物方面两组差异无显著性意义(P>0.05);⑤提示鸡尾酒疗法联合股神经阻滞能缓解全膝关节置换后早期的静息性疼痛,对早期膝关节活动度有一定的改善,且安全有效。

BACKGROUND:Total knee arthroplasty is an important measure to save the function of knee joint,but the postoperative pain caused great pain to patients.On the background of multimodal analgesia,cocktail therapy and femoral nerve block are widely used in clinic,and the analgesic effect is exact;however,the analgesic effect and safety of the two methods used together are unknown,so more clinical evidence is needed.OBJECTIVE:To study the effect and safety of analgesic and functional recovery of cocktail therapy combined with femoral nerve block after total knee arthroplasty.METHODS:Totally 100 patients undergoing primary unilateral total knee arthroplasty were enrolled.One hundred patients were randomly divided into two groups(n=50 per group)according to the table of random numbers.Group A was given cocktail therapy combined with femoral nerve block;group B received the injection of same volume of normal saline surrounding the knee joint combined with femoral nerve block.The postoperative resting-state visual analogue scale score,knee joint range of motion,global pain scale,and incidences of adverse reactions were compared between groups.The time and frequency of analgesic drugs were recorded.RESULTS AND CONCLUSION:(1)The postoperative visual analogue scale score at rest in the group A was significantly lower than that in the group B at 24,36 and 48 hours postoperatively(P<0.05).The scores at 12 and 72 hours did not differ significantly between groups(P>0.05).(2)The knee joint range of motion on postoperative 1 and 3 days in the group A was significantly higher than that in the group B(P<0.05),and no significant difference was detected at 14 days,1 and 3 months postoperatively(P>0.05).(3)At 3 months after operation,there was no significant difference in the Global Pain Scale between the two groups(P>0.05).(4)There was no significant difference in incidences of adverse reactions and additional analgesics between the two groups(P>0.05).(5)In summary,cocktail therapy combined with femoral nerve block can relieve the early resting pain after total knee arthroplasty,and improve the activity of knee joint in the early stage,which is safe and effective.