超声引导下收肌管联合IPACK阻滞用于全膝关节置换术中的临床效果

The clinical effect of ultrasound-guided adductor canal combined with IPACK blocks in patients undergoing total knee arthroplasty

目的探讨在全膝关节置换术(TKA)应用超声引导下收肌管联合腘动脉与膝关节后囊间隙(IPACK)阻滞的镇痛效果。方法选取2017年1月至2020年4月在安徽医科大学第三附属医院(合肥市第一人民医院)择期行TKA的患者80例(年龄54~85岁)为研究对象,ASA分级Ⅰ~Ⅲ级。采用随机数字表法,分为单纯收肌管阻滞组(S组)与收肌管联合IPACK阻滞组(Ⅰ组),每组40例。两组患者都在气管内全麻或喉罩全麻下完成手术,术后给予自控静脉镇痛。分别记录手术后4(T_(1))、8(T_(2))、12(T_(3))、24(T_(4))和48小时(T_(5))各个时间点的静息和运动态的疼痛数字(NRS)评分;NRS评分>4分则给予补救镇痛;记录补救镇痛患者的比例和患者首次下床时间及术后关节活动度与舒适度评分,记录镇痛泵有效按压次数和不良反应情况。结果与S组比较,I组患者在T_(1)~T_(3)时点的静息态和运动态NRS评分均较低,差异有统计学意义(P<0.001)。与S组比较,I组患者在T_(1)~T_(3)时点的膝关节活动度增大,差异有统计学意义(P<0.05);I组患者在T_(1)~T_(5)舒适度提高,差异有统计学意义(P<0.05)。与S组比较,I组患者手术后首次下床时间较早,术后需要补救镇痛的比例降低,术后48 h以内镇痛泵按压次数减少,差异有统计学意义(P<0.05);两组患者术后恶心、呕吐、谵妄等不良反应发生率比较,差异无统计学意义(P>0.05)。结论在TKA应用超声引导下收肌管联合IPACK阻滞的镇痛效果明显优于单纯收肌管阻滞。

Objective To investigate the analgesic effect of ultrasound-guided adductor canal combined with infiltration between the popliteal artery and capsule of the knee(IPACK)block in patients undergoing total knee arthroplasty(TKA).Methods From January 2017 to April 2020,80 patients(aged 54~85 years)scheduled for TKA in the Third Affiliated Hospital of Anhui Medical University(the First People’s Hospital of Hefei City)were selected as the research objects,allocated to American Society of Anesthesiologists(ASA)grade Ⅰ~Ⅲ.They were randomly divided into two groups using a random number table method:adductor canal block alone group(group S)and adductor canal+IPACK block group(group Ⅰ),40 of each.All patients were performed general anesthesia under tracheal intubation or laryngeal mask before ultrasound-guided local block,and received patient-controlled intravenous analgesia(PCIA)after surgery.Numerical Rating Scale(NRS)score were recorded at the 4(T_(1)),8(T_(2)),12(T_(3)),24(T_(4))and 48 hour(T_(5))after surgery.Patients were injected with flurbiprofen 50 mg intravenous if NRS score was larger than 4.The times of PCIA self-administration,range of joint motion,comfort scores and the adverse effects within 48 hours after surgery were recorded.Results Compared with group S,patients in group I had lower resting and exercise NRS scoresat time T_(1)~T_(3),and the difference was statistically significance(P<0.001).Compared with group S,the range of joint motion increased at time T_(1)~T_(3)in group I,and the difference was statistically significant(P<0.05);the comfort scores of group I increased at time T_(1)~T_(5),and the difference was statistically significant(P<0.05).Compared with group S,patients in group I got out of bed earlier after operation,the proportion of patients who needed rescue analgesia decreased,and the number of pressing analgesia pump within 48 hours after operation decreased,and the differences were statistically significant(P<0.05);there was no statistically significant difference in the incidence of postoperative nausea,vomiting,delirium and other adverse reactions between the two groups(P>0.05).Conclusions The analgesic effect of ultrasound-guided adductor canal combined with IPACK block is significantly better than that of adductor canal block alone in treating patients undergoing TKA.