不同浓度罗哌卡因持续股神经阻滞对全膝关节置换术后康复的影响

Effect of Continuous Femoral Nerve Block with Different Concentrations of Ropivacaine on Rehabilitation after Total Knee Arthroplasty

目的:探讨不同浓度罗哌卡因持续股神经阻滞(CFNB)对全膝关节置换术(TKA)后康复质量的影响。方法:选择2020年1月-2021年6月入南通大学附属医院择期行单侧TKA患者共90例,将患者采用随机数字表法分为0.1%组(0.1%罗哌卡因)、0.15%组(0.15%罗哌卡因)和0.2%组(0.2%罗哌卡因),每组30例。比较三组康复出院时间和首次独立下床活动时间,术后18、24、48 h徒手肌力测试(MMT)评分,术后18、24、48 h和术后3、4 d静息和运动状态下疼痛数字量表评分(NRS),补救性镇痛和不良事件发生率。结果:三组康复出院时间和首次独立下床时间比较,差异均有统计学意义(P<0.05);0.1%组康复出院时间和首次独立下床时间均长于0.15%组和0.2%组(P<0.05);但0.15%组和0.2%组康复出院时间和首次独立下床时间比较,差异均无统计学意义(P>0.05)。三组术后18、24、48 h的MMT评分比较,差异均有统计学意义(P<0.05);0.15%组和0.2%组术后18 h的MMT评分均低于0.1%组,0.2%组术后24、48 h的MMT评分均低于0.1%组和0.15%组(P<0.05)。三组术后18、24 h静息和运动状态下NRS评分比较,差异均无统计学意义(P>0.05);三组术后48 h和术后3、4 d静息和运动状态下NRS评分比较,差异均有统计学意义(P<0.05);且0.1%组术后48 h和术后3、4 d静息和运动状态下NRS评分均高于0.15%组和0.2%组(P<0.05),但0.15%组和0.2%组比较差异均无统计学意义(P>0.05)。三组补救性镇痛和不良事件发生率比较,差异均无统计学意义(P>0.05)。结论:TKA后康复推荐应用0.15%罗哌卡因CFNB,能缩短出院时间和首次下床时间,提高股四头肌MMT评分,缓解静息和运动疼痛,且不增加补救性镇痛和不良事件发生率。

Objective:To investigate the effect of continuous femoral nerve block (CFNB) with different concentrations of Ropivacaine on the quality of rehabilitation after total knee arthroplasty (TKA).Method:A total of 90 patients who were admitted to Affiliated Hospital of Nantong University for elective unilateral TKA from January 2020 to June 2021 were selected,and the patients were divided into 0.1% group (0.1% Ropivacaine) and 0.15% group (0.15% Ropivacaine) and 0.2% group (0.2% Ropivacaine) by random number table method,30 cases in each group.The time of recovery and discharge,the time of first independent getting out of bed,the scores of manual muscle strength test (MMT) at 18,24,and 48 hours after operation,and numerical rating scale (NRS) scores of pain at rest and exercise at 18 hours,24 hours,48 hours,3 days,4 days after operation,remedial analgesia and adverse event rates were compared among the three groups.Result:There were statistically significant differences in the time of recovery and discharge and the time of first independent getting out of bed among three groups (P<0.05);the time of recovery and discharge and the time of first independent getting out of bed in 0.1% group were longer than those in 0.15% group and 0.2% group (P<0.05);but there were no statistically significant differences in the time of recovery and discharge and the time of first independent getting out of bed between 0.15% group and 0.2% group (P>0.05).There were statistically significant differences in the MMT scores of the three groups at 18,24 and 48 h after operation (P<0.05).The MMT scores in 0.15% group and 0.2% group at 18 h after operation were lower than than in 0.1% group,the MMT scores in 0.2% group at 24 and 48 h after operation were lower than those in 0.1% group and 0.15% group (P<0.05).There were no significant differences in the NRS scores among three groups at 18 and 24 h after operation of rest and exercise state (P>0.05);there were significant differences in the NRS scores among three groups at 48 h,3 d,and 4 d after operation of rest and exercise state (P<0.05);and the NRS scores of 0.1% group at 48 h,3 d,and 4 d after operation of rest and exercise state were higher than those in 0.15% group and 0.2% group (P<0.05),but there were no significant difference between 0.15% group and the 0.2% group (P>0.05).There were no significant differences in the rates of remedial analgesia and adverse events among three groups (P>0.05).Conclusion:0.15% Ropivacaine CFNB is recommended for rehabilitation after TKA,it can shorten the times of recovery and discharge and first independent getting out of bed,improve MMT score of quadriceps femoris,relieve pain at resting and exercise,and does not increase the incidence of remedial analgesia and adverse events.