连续收肌管阻滞镇痛在双膝关节一期置换术后疼痛控制研究

Study on pain control of continuous adductor block analgesia after primary knee replacement

目的:探讨连续收肌管阻滞在双膝关节一期置换术后疼痛控制效果。方法:回顾性分析2018年1月至2019年1月收治的24例行双膝关节一期置换术,且术后行连续收肌管阻滞镇痛患者资料。男6例,女18例;年龄60~72(65.05±5.82)岁。患者术后双膝均行连续收肌管阻滞,配合自控镇痛系统。术后4、6、12、24、36、48 h行静息状态及被动运动状态视觉模拟评分(visual analogue scale,VAS);随访患者术后1周及1、3、6个月膝关节活动度;对患者术后6个月膝关节功能进行评分,采用美国特种外科医院(Hospital for Special Surgery,HSS)膝关节评分标准;记录不良反应及并发症。结果:行连续收肌管阻滞患者术后各时点静息状态、被动运动状态VAS均分<3分。患者术后膝关节活动度较好,术后6个月HSS评分优20例,良2例,可1例,差1例。术后仅4例出现恶心呕吐,无一例发生心动过缓、深静脉血栓等严重不良反应及并发症。结论:连续收肌管阻滞在双膝关节一期置换术后疼痛控制方面效果显著,且不良反应较少。

Objective:To investigate the effect of continuous adductor block on pain control after bilateral knee jointⅠ-stage replacement.Methods:A retrospective analysis was made of the data of 24 patients with bilateral knee joint I-stage replacement who were treated in our hospital from January 2018 to January 2019,and who underwent continuous adductor block analgesia.There were 6 males and 18 females,aged 60 to 72(65.05±5.82)years old.The patients underwent continuous block of adductor canal with patient-controlled analgesia system.At 4,6,12,24,36 and 48 hours after operation,visual analogue score(VAS)of resting state and passive motion state was performed;the knee joint activity was followed up for 1 week,1,3 and 6 months after operation;the knee joint function was scored at 6 months after operation,using the knee joint scoring standard of American Special Surgery Hospital(HSS);adverse reactions and complications were recorded.Results:The VAS scores under resting state and passive motion state at each time point were less than 3 points in patients with continuous adductor block.The patients had better postoperative exercise of knee joint activity.The score of HSS was excellent in 20 cases,good in 2 cases,fair in 1 case and poor in 1 case.There were only 4 cases of nausea and vomiting,none of them had serious adverse reactions and complications such as bradycardia and deep vein thrombosis.Conclusion:Continuous adductor block has a significant effect on pain control and less adverse reactions after bilateral knee jointⅠ-stage replacement.