超声引导下持续收肌管阻滞和股神经阻滞用于全膝关节置换术后镇痛的效果比较

Comparison of analgesia effect of ultrasound-guided continuous adductor canal block versus femoral nerve block after total knee arthroplasty

目的比较超声引导下持续收肌管阻滞和股神经阻滞用于全膝关节置换术后镇痛的效果。方法回顾性纳入2018年1月至2020年12月洛阳正骨医院收治的行单侧膝关节置换患者120例。根据镇痛方式分为两组。收肌管组64例术后行持续收肌管阻滞镇痛, 股神经组56例术后行股神经阻滞镇痛。比较两组术后不同时间点静息状态及运动状态的视觉模拟量表(VAS)评分、股四头肌肌力、膝关节活动度, 统计术后镇痛不良反应发生情况。结果术后12 h, 两组静息状态、运动状态VAS评分高于术后3 h(P<0.05)。术后24、28 h, 两组静息状态、运动状态VAS评分呈下降趋势。术后1、3、7 d, 两组股四头肌肌力、膝关节活动度逐渐升高, 且收肌管组股四头肌肌力、膝关节活动度高于同时间点的股神经组(t=5.92、6.410、7.843、5.502、6.829、9.967, P<0.05)。两组不良反应发生率比较, χ^(2)=0.011, P=0.916。结论超声引导下持续收肌管阻滞和股神经阻滞术后镇痛效果和安全性相当, 但采用收肌管阻滞的患者术后股四头肌肌力和膝关节活动度恢复较快, 有利于术后早期康复训练。

Objective To compare the analgesia effect of ultrasound-guided continuous adductor canal block and femoral nerve block after total knee arthroplasty.Methods A retrospective collection of 120 patients who underwent unilateral knee arthroplasty admitted to Luoyang Orthopedic Hospital from January 2018 to December 2020,and they were divided into two groups according to the method of analgesia.Sixty-four patients in the adductor canal group received continuous adductor canal block analgesia after operation,and 56 patients in the femoral nerve group received femoral nerve block analgesia after operation.The visual analogue scale(VAS)scores,quadriceps muscle strength,and knee joint range of motion of resting and exercise were compared between the two groups at different time points after surgery,the incidence of adverse reactions of postoperative analgesia was counted.Results At 12 hours after operation,the VAS scores of resting and exercise in the two groups were higher than that at 3 hours after operation(P<0.05).At 24 and 28 hours after operation,the VAS scores of resting and exercise in the two groups showed a downward trend.After 1,3 and 7 days after operation,the quadriceps muscle strength and knee joint mobility in the two groups gradually increased.The quadriceps muscle strength and knee joint mobility in the adductor canal group were higher than those in the femoral nerve group at the same time point(t=5.92,6.410,7.843,5.502,6.829,9.967,P<0.05).The incidence of adverse reactions were compared between the two groups,χ^(2)=0.011,P=0.916.Conclusions Ultrasound-guided continuous adductor tube block and femoral nerve block have the same analgesia effect and safety,but the adductor canal block can quickly restore quadriceps muscle strength and knee joint mobility,which is beneficial to early rehabilitation training after surgery.