摘要
目的比较超声引导下采用不同浓度罗哌卡因行收肌管阻滞(ACB)对全膝置换术(TKA)后镇痛效果及股四头肌肌力的影响。方法选取拟在喉罩全麻下行单侧膝置换手术患者60例,男33例,女27例,年龄50~75岁,BMI 17~25 kg/m^2,ASAⅠ-Ⅲ级,随机分为三组:0.25%罗哌卡因组(R1组)、0.375%罗哌卡因组(R2组)和0.5%罗哌卡因组(R3组),每组20例。患者均于术毕即刻于超声下行术侧ACB。记录术后4、8、12、24、48 h静息和运动时的VAS评分,记录术前1 d、术后4、8、12、24、48 h的股四头肌肌力分级,记录术前1 d、术后24、48 h膝关节活动度(ROM),并记录术后48 h内PCIA内舒芬太尼使用量,补救镇痛次数,恶心呕吐、尿潴留等并发症的发生情况。结果与术后4 h比较,术后12、24、48 h R1组静息和运动VAS疼痛评分明显升高(P<0.05)。与R1组比较,术后12、24、48 h R2、R3组静息和运动VAS疼痛评分明显降低(P<0.05)。与术前1 d比较,术后4、8、12、24 h R1组、R2组股四头肌肌力明显降低(P<0.05);术后4、8、12、24、48 h R3组股四头肌肌力明显降低(P<0.05)。与R3组比较,术后48 h R1组、R2组股四头肌肌力明显升高(P<0.05)。与术前1 d比较,术后24、48 h三组ROM明显降低(P<0.05);与R1组比较,术后24、48 h R2、R3组ROM明显升高(P<0.05)。与R1组比较,R2、R3组术后48 h内PCIA内舒芬太尼使用量明显减少,补救镇痛率、恶心呕吐和尿潴留发生率明显降低(P<0.05)。结论全膝关节置换术后镇痛采用0.375%罗哌卡因收肌管阻滞较0.25%浓度镇痛效果明显,减少术后阿片类药物使用量及并发症,较0.5%浓度有更强的股四头肌肌力及更高的膝关节活动度,有助于患者的术后快速康复。
Objective To compare the postoperative analgesia and quadriceps strength among patients undergoing total knee arthroplasty(TKA)with different concentration ropivacaine by ultrasound-guided adductor canal block(ACB).Methods Sixty patients scheduled to undergo unilateral TKA with general anesthesia,aged 50-75 years,BMI 17-25 kg/m^2,ASA physical statusⅠ-Ⅲ,were recruited.They were randomly divided into three groups,0.25%ropivacaine(group R1),0.375%ropivacaine(group R2)and 0.5%ropivacaine(group R3).All patients were conducted ACB by ultrasound immediately after surgery.VAS pain scores of resting and active conditions at 4,8,12,24,and 48 h after operation were recorded.Grades of quadriceps strength were recorded at 1 d before and 4,8,12,24,and 48 h after operation.The joint activity range of motion(ROM)was recorded on preoperative 1 d and 24 h,48 h after operation.Sufentanil dosage within PCIA,supplement times of analgesia,complications such as nausea and vomiting,and urinary retention within 48 h after operation were recorded.Results Compared with 4 h after operation,VAS pain scores of resting and active conditions in group R1 were significantly increased at 12,24,48 h after operation(P<0.05).The VAS pain scores of resting and active conditions in groups R2,R312,24,48 h after operation were significantly lower than those in group R1(P<0.05).Compared with 1 d before operation,quadriceps muscle strength of group R1,R2 decreased significantly 4,8,12,24 h after operation(P<0.05).The quadriceps muscle strength of group R3 decreased significantly 4,8,12,24,48 h after operation(P<0.05).Quadriceps strength in group R348 h after operation were significantly lower than those in groups R1 and R2(P<0.05).The ROM in groups R1,R2,R3 at 24,48 h after operation were significantly lower than 1 d before operation(P<0.05).The ROM in groups R2,R324,48 h after operation were significantly higher than group R1(P<0.05).Amount of sufentanil dosage in PCIA,times of analgesia rescue,nausea,vomiting,and urinary retention within 48 h after operation in groups R2,R3 were significantly lower than group R1(P<0.05).Conclusion Compared with 0.25%ropivacaine,ACB with 0.375%ropivacaine produces better analgesic effect,less postoperative opioid use and adverse events in TKA.Additionally,it has better quadriceps strength and higher joint activity range of motion than 0.5%ropivacaine,which is conductive to the rapid postoperative rehabilitation.
作者
高玉洁
陈利海
蒋卫清
韩流
张媛
单涛
王宏宇
斯妍娜
鲍红光
GAO Yujie;CHEN Lihai;JIANG Weiqing;HAN Liu;ZHANG Yuan;SHAN Tao;WANG Hongyu;SI Yanna;BAO Hongguang(Department of Anesthesiology,Nanjing Hospital Affiliated to Nanjing Medical University,Nanjing First Hospital,Nanjing 210006,China)
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2020年第11期1055-1058,共4页
Journal of Clinical Anesthesiology
基金
国家自然科学基金(81873954)
江苏省“六大人才高峰”高层次人才项目(WSW-106)。