连续外周神经阻滞对膝关节僵直松解术早期疼痛的影响

Continuous Peripheral Nerve Block for Early Pain Management in Knee Angiolysis

目的探讨连续外周神经阻滞对膝关节僵直松解术后早期疼痛管理的影响。方法选择膝关节术后膝关节僵直患者,随机分为连续收肌管阻滞组(A组)与连续股神经阻滞组(F组),于全身麻醉下行膝关节松解术,术毕分别留置神经阻滞导管实施镇痛方案。术后观察术后2h、6h、12h、24h、48h、72h静息、活动(膝关节最大屈曲度)状态下的疼痛评分(NRS评分)及患肢股四头肌肌力;术后补救性盐酸羟考酮用量及不良反应等情况。术后第1、2、3、7天,2、6、12、24周测量膝关节主动活动度(ROM)。结果两组共纳入40例患者,每组20例。参与研究的患者术前基线数据无差异。两组患者术后静息和活动状态下的NRS评分无统计学差异;术后补救性盐酸羟考酮用量及相关并发症无统计学差异。术后12h、24h、48h和72hA组患肢股四头肌肌力高于F组,差异有统计学意义(P<0.05);术后第1天、第2天、第3天、第7天、第14天、第6周A组患者ROM大于F组,差异有统计学意义(P<0.05)。结论连续外周神经阻滞对膝关节僵直松解术后患者早期疼痛效果良好,连续收肌管阻滞相比较连续股神经阻滞可以获得更好的早期康复效果。

Objective To investigate the effect of continuous peripheral nerve block on early rehabilitation pain management after knee ankylosis.Methods Patients with knee stiffness after knee joint operation were randomly divided into continuous adductor canal block group(group A)and continuous femoral nerve block group(group F).The knee joint manipulation was performed under general anesthesia,after the operation,nerve block catheters were indwelling for analgesia.The pain score(NRS score)in resting and active state(maximum knee flexure)after surgery and the muscle strength of the quadriceps femoris of the affected limb were observed at 2h,6h,12h,24h,48hand 72h.Postoperative remedial oxycodone hydrochloride dosage and analgesic adverse reactions.The knee joint active range of motion(ROM)was measured at 1,2,3,and 7days after surgery,at 2,6,12,and 24weeks.Results A total of 40patients were enrolled in the two groups,20patients in each group.There was no difference in preoperative baseline data among patients enrolled in the study.There was no statistical difference in the NRS scores between the two groups of patients in the resting and active state after the operation;there was no statistical difference in the postoperative salvage oxycodone hydrochloride dosage and related complications.The quadriceps muscle strength of the affected limb in group A was higher than that in group F at 12hours,24hours,48hours and 72hours after operation,and the difference was statistically significant(P<0.05);On day 2,day 3,day 7,day 14,and week 6,the ROM of group A was greater than that of group F,and the difference was statistically significant(P<0.05).Conclusion Continuous peripheral nerve block has a good effect on early pain in patients after knee joint stiffness release.Compared with continuous femoral nerve block,continuous adductor tube block can achieve better early rehabilitation effect.