持续股神经阻滞对全膝关节置换术后疼痛和功能康复的影响

Application of continuous femoral nerve block in function recovery after the total knee arthroplasty

目的探讨持续股神经阻滞对全膝关节置换术(total knee arthroplasty,TKA)后疼痛和关节功能康复的影响。方法选取2015年1月至2018年6月在四川省人民医院天府新区分院诊断为膝关节骨关节炎并行单侧TKA的患者70例,根据镇痛方式的不同分为治疗组和对照组,每组35例。对照组患者TKA术后采用持续静脉注射镇痛,治疗组采用持续股神经阻滞进行镇痛。采用视觉模拟量表评估两组患者术后4、8、12、24、48h休息时的疼痛严重程度(rest visual analogue score,RVAS),术后24、48h被动活动时的疼痛严重程度(passive visual analogue score,PVAS)。于术前及术后1、2d测量两组患者的膝关节屈伸活动度,并记录两组患者术后主动屈膝到90°所需的时间、吗啡使用率及麻醉药物相关不良反应的发生情况。结果治疗组术后8、12、24、48h的RVAS和24、48h的PVAS均低于对照组,差异有显著性(P<0.05)。治疗组术后1、2d的膝关节屈伸活动度均高于对照组,差异有显著性(P<0.05)。治疗组术后主动屈膝到90°所需的时间为(4.3±0.8) d,明显短于对照组的(6.8±0.9) d,差异有显著性(P<0.05)。治疗组吗啡使用率及麻醉药物相关不良反应发生率均低于对照组,差异有显著性(P<0.05)。结论持续股神经阻滞可提供较好的术后镇痛效果,从而促进术后运动,提高康复效果,且该方法操作简便、安全,可用于TKA术后镇痛。

Objective To evaluate the effect of continuous femoral nerve block(CFNB)in function recovery after total knee arthroplasty(TKA).Method 70 patients diagnosed with knee osteoarthritis and undergoing unilateral TKA surgery from January 2015 to June 2018 were selected and divided into treatment group(35 cases)and control group(35 cases)according to different analgesia methods.All patients in experiment group were administrated with CFNB after operation while patients in control group with continuous intravenous analgesia(CIA).Postoperative pain in both groups was assessed by visual analogue scale.The range of motion(ROM)of knee joint was measured.Morphine requirement and drug toxicity were recorded in both groups.Result The RVAS at 8,12,24 and 48h and PVAS at 24 and 48h after knee replacement in the treatment group were lower than those in the control group,and the difference between the two groups was statistically significant(P<0.05);There was no statistically significant difference in RVAS between the two groups at 4h after surgery(P<0.05).ROM of the treatment group was higher than that of the control group at 1 and 2 days after operation,and the difference was statistically significant(P<0.05).The number of days required for active knee flexion to 90 degrees in the treatment group was lower than that in the control group,and the difference between the two groups was statistically significant(P<0.05).Morphine requirement and the incidence of drug side effects in the treatment group were lower than those in the control group,and the differences between the two groups were statistically significant(P<0.05)Conclusion Continuous femoral nerve block can provide better postoperative analgesic effect,thus promoting postoperative exercise and improving postoperative rehabilitation effect.Moreover,this treatment is simple and safe,and can be better applied to postoperative analgesia after TKA.