股神经阻滞联合闭孔神经阻滞在全膝关节置换病人术后镇痛中的效果

Effect of femoral nerve block combined with obturator nerve block on postoperative analgesia in patients with total knee arthroplasty

目的:观察股神经阻滞联合闭孔神经阻滞在全膝关节置换病人术后镇痛中的效果。方法:选择择期行单侧全膝关节置换术病人40例,性别不限,年龄55~75岁,ASA分级Ⅰ或Ⅱ级,随机数字表法分为2组(n=20):股神经阻滞组(A组)、股神经阻滞联合闭孔神经阻滞组(B组)。麻醉诱导完成后,2组均在超声引导下行术侧股神经阻滞,推注0.5%罗哌卡因20 mL;随后B组通过超声引导行术侧闭孔神经阻滞,推注0.5%罗哌卡因10 mL。术后VAS评分≥3分时行PCIA,镇痛药物为纳布啡1.5 mg/kg,剂量3 mL/h,锁定时间25 min。若VAS评分仍≥3分,静脉注射纳布啡0.1 mg/kg补救镇痛。记录开始使用镇痛药物的时间、术后24 h和48 h纳布啡总用量、神经阻滞相关并发症发生率,不良反应瘙痒及恶心、呕吐的发生情况。结果:与A组比较,B组开始使用镇痛药物的时间延长,术后24 h纳布啡总用量、术后48 h纳布啡总用量少于A组(P<0.01);2组瘙痒及恶心、呕吐的发生率差异无统计学意义(P>0.05)。2组均无神经阻滞相关并发症。结论:股神经阻滞联合闭孔神经阻滞在全膝关节置换病人术后镇痛中的效果优于单纯股神经阻滞。

Objective:To evaluate the effects of femoral nerve block combined with obturator nerve block on postoperative analgesia in patients with total knee arthroplasty.Methods:Forty patients scheduled by unilateral total knee arthroplasty,any gender,age 55-75 years old and ASA classⅠorⅡwere randomly divided into the femoral nerve block group(group A,20 cases)and femoral nerve block combined with obturator nerve block group(group B,20 cases).After anesthesia induction,two groups were treated with the femoral nerve blocking guided by ultrasound and 20 mL of 0.5%ropivacaine injection.The group B was treated with lateral obturator nerve block guided by ultrasound,and injected with the 10 mL of 0.5%ropivacaine.When the postoperative visual analog scale(VAS)score was≥3 points,the 0.1 mg/kg of nalbuphine was intravenously injected with 3 mL/h and locking time for 25 min.If the VAS score was still≥3 points,the intravenous naboo was injected with 0.1 mg/kg to remedy the analgesia.The time to start using analgesics,total naboo dosage after 24 h and 48 h of surgery,incidence rate of neuroblock-related complications,and occurrence of pruritus,nausea and vomiting of adverse reactions were recorded.Results:Compared with the group A,the time to start using analgesics in group B prolonged,and the total naboo dosage in group B after 24 h and 48 h of surgery were less than those in group A(P<0.01).The differences of the incidence rates of nausea,vomiting and itching between two groups were not statistically significant(P>0.05).No nerve block-related complication was found in two groups.Conclusions:The postoperative analgesia effects of femoral nerve combined with obturator nerve block is better than that of femoral nerve block alone in patients with total knee arthroplasty.