布比卡因联合地塞米松用于关节镜前交叉韧带重建术后收肌管阻滞的镇痛效果及对患者早期康复的影响

Analgesic effect of bupivacaine combined with dexamethasone on adductor canal block after arthroscopic anterior cruciate ligament reconstruction and effect on early rehabilitation of patients

目的探讨布比卡因联合地塞米松用于关节镜前交叉韧带重建术(ACL)后收肌管阻滞(ACB)的镇痛效果及对患者早期康复的影响。方法选择2016年12月至2018年12月于中国人民武装警察部队宁夏回族自治区总队医院行关节镜ACL的患者86例,按照随机数字表法分为对照组和观察组,各43例。2组患者均为择期手术,且术中均给予硬膜外麻醉,对照组麻醉诱导前给予布比卡因+0.9%氯化钠注射液单次推注进行ACB;观察组麻醉诱导前给予布比卡因+地塞米松单次推注进行ACB,比较2组患者感觉及运动阻滞起效及持续时间,术前及术后4、6、12、24、48 h静息状态及运动状态下疼痛视觉模拟量表(VAS)评分,手术和住院相关指标以及不良反应发生率。结果观察组感觉及运动阻滞持续时间均长于对照组[(17.5±3.0) h比(12.6±2.3) h、(12.0±1.2) h比(9.4±1.4) h](均P <0.05)。术后各时点,观察组静息及运动状态下VAS评分均显著低于对照组,且2组患者术后各时点静息及运动状态下VAS评分均显著低于术前(均P <0.05)。观察组患者术后下床时间早于对照组[(21±3) h比(24±4) h],住院时间短于对照组[(3.3±0.7) d比(4.2±0.9) d],双氯芬酸钠及哌替啶使用率均低于对照组[27.9%(12/43)比53.5%(23/43)、4.7%(2/43)比18.6%(8/43)](均P <0.05)。2组不良反应发生率比较差异无统计学意义(P> 0.05)。结论 ACL患者采用布比卡因联合地塞米松进行ACB镇痛效果较好,且能促进患者早期康复。

Objective To investigate the analgesic effect of dexamethasone combined with bupivacaine on adductor canal block(ACB)after arthroscopic anterior cruciate ligament(ACL)reconstruction and its effect on early rehabilitation.Methods From December 2016 to December 2018,86 patients who underwent arthroscopic ACL surgery in Ningxia Hui Autonomous Region General Hospital of the Chinese Armed Police Force were selected.All patients were randomly divided into observation group(43 cases)and control group(43 cases).All patients underwent elective surgery and epidural anesthesia was performed during the operation.ACB was performed before the induction of anesthesia.The control group received ACB with bupivacaine+0.9%sodium chlorid before anesthesia and the observation group received ACB with bupivacaine+dexamethasone before anesthesia.The onset time of sensory and motion block.The onset and duration of sensory and motor block,the visual analogue scale(VAS)score in resting state and exercise state before and 4,6,12,24,48 h after operation,surgical and inpatient related indicators and the incidence of adverse reactions were compared between the two groups.Results The duration of sensory and motion block in observation group were longer than those in control group[(17.5±3.0)h vs(12.6±2.3)h,(12.0±1.2)h vs(9.4±1.4)h](both P<0.05).At each time point after operation,the rest and exercise VAS scores in the two groups at each postoperation time point were significantly lower than those before operation;the VAS scores in observation group were significantly lower than those in control group(all P<0.05).The time of getting out of bed in observation group was earlier than that in control group[(21±3)h vs(24±4)h];the time of hospitalization in observation group was shorter than that in control group[(3.3±0.7)d vs(4.2±0.9)d];the utilization rate of diclofenac sodium and pethidine in observation group were lower than those in control group[27.9%(12/43)vs 53.5%(23/43),4.7%(2/43)vs 18.6%(8/43)](all P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Dexamethasone combined with bupivacaine show good analgesia efficacy on patients underwent ACB after arthroscopic ACL reconstruction;it can improve early rehabilitation.