超声引导下收肌管阻滞与传统静脉给药对胫骨骨折切开复位内固定术后的镇痛效果比较

Comparison of analgesic effect of ultrasound-guided adductor canal block and traditional intravenous administration on fracture of tibia after open reduction and internal fixation

目的比较超声引导下收肌管阻滞与传统静脉给药用于胫骨骨折术的疗效。方法选取2018年12月至2019年12月江苏省无锡市第九人民医院收治的80例胫骨骨折患者,按照随机数字表法分为两组,每组40例。对照组给予传统静脉给药镇痛,观察组给予超声引导下收肌管阻滞镇痛。采用视觉模拟评分法(VAS)评估两组术后屈膝及静息时疼痛程度,镇静状态评分(Ramsay评分)评估两组术后静息状态,比较两组治疗满意度,监测术后芬太尼使用量、镇痛泵有效按压次数及氟比洛芬酯的用量,记录住院时间及不良反应发生情况。结果两组屈膝及静息时VAS评分不同时间点两两比较,差异有统计学意义(P<0.05);术后8、24、48 h,观察组屈膝及静息时VAS评分低于对照组,差异有统计学意义(P<0.05)。术后24 h,两组Ramsay评分低于术后4 h,差异有统计学意义(P<0.05);术后4、24 h,观察组Ramsay评分均低于对照组,差异有统计学意义(P<0.05)。观察组芬太尼用量、镇痛泵有效按压次数、氟比洛芬酯总用量及使用率低于对照组,住院时间短于对照组,患者满意度高于对照组,差异有统计学意义(P<0.05)。观察组不良反应总发生率低于对照组,差异有统计学意义(P<0.05)。结论收肌管阻滞相较于传统静脉给药,疗效显著且安全性良好。

Objective To investigate the curative effect of ultrasound-guided adductor canal block and traditional intravenous administration for fracture of tibia.Methods A total of 80 patients with fracture of tibial admitted to Wuxi Ninth People’s Hospital,Jiangsu Province from December 2018 to December 2019 were selected,they were divided into two groups by random number table method,with 40 patients in each group.The control group was given traditional intravenous administration analgesia,and the observation group was given ultrasound-guided adductor canal block analgesia.Visual analogue scale(VAS)was used to evaluate the pain degree at postoperative knee bend and rest,and the sedation state score(Ramsay score)was used to evaluate the postoperative rest state of the two groups,the treatment satisfaction of two groups were compared,the amount of Fentanyl in the postoperative analgesic pump,the effective pressing times of the analgesic pump and the amount of Flurbiprofen Axetil were monitored,and the length of hospital stay and the occurrence of adverse reactions were recorded.Results VAS scores at knee bend and rest of two groups were pairwise compared at different time points,and the differences were statistically significant(P<0.05);VAS score at knee bend and rest of observation group were lower than those of control group at 8,24 h,and 48 h postoperatively,and the differences were statistically significant(P<0.05).At 24 h postoperatively,Ramsay scores of both groups were lower than those at 4 h postoperatively,and the differences were statistically significant(P<0.05);at 4 h and 24 h postoperatively,the Ramsay scores of the observation group were lower than those of the control group,and the differences were statistically significant(P<0.05).The amount of Fentanyl,the effective pressing times of the analgesic pump and the total dosage and usage rate of Flurbiprofen Axetil of observation group were lower than those of control group,and the length of hospital stay were shorter than that of control group,and patient satisfaction was higher than that of control group,and the differences were statistically significant(P<0.05).The total incidence of adverse reactions in observation group was lower than that in control group,and the difference was statistically significant(P<0.05).Conclusion Ultrasound-guided adductor canal block has better efficacy and safety than traditional intravenous administration.