不同容量罗哌卡因收肌管中点阻滞对全膝关节置换术后镇痛效果的比较

Comparison of the postoperative analgesic effect of different-volume ropivacaine on adductor canal midpoint block for total knee arthroplasty

目的比较超声定位下不同容量罗哌卡因收肌管(adductor canal,AC)中点阻滞老年全膝关节置换(total knee arthroplasty,TKA)术后的镇痛效果及不良反应。方法纳入择期行单侧全膝关节置换术的老年患者90例,随机分为罗哌卡因10 ml组、20 ml组和30 ml组,每组30例。所有患者均在术后行超声定位下AC中点阻滞。记录术后6、12、24和48 h静息和运动VAS评分;术后48 h累积舒芬太尼和地佐辛用量;术前,术后24、48 h股四头肌肌力和主动膝关节活动度(ROM)及恶心呕吐等不良反应发生率。结果与罗哌卡因10 ml组比较,罗哌卡因20 ml、30 ml组术后各时间点静息和运动VAS评分降低(P<0.05),术后48 h累积舒芬太尼和地佐辛用量减少(P<0.05),恶心、呕吐发生率降低(P<0.05);术后24、48 h主动ROM增加(P<0.05);但上述指标罗哌卡因20 ml、30 ml组间比较差异均无统计学意义(P>0.05)。术后24 h罗哌卡因10 ml、20 ml组股四头肌肌力均高于罗哌卡因30 ml组(P<0.05),罗哌卡因10 ml、20 ml组间差异无统计学意义(P>0.05)。结论0.375%罗哌卡因20 ml AC中点阻滞能为TKA术后提供良好的镇痛,并且对股四头肌肌力抑制弱,有利于患者术后膝关节功能恢复。

Objective To compare the postoperative analgesic effect and adverse reactions of different-volume ropivacaine during adductor canal(AC)midpoint block guided by ultrasound positioning in elderly patients after total knee arthroplasty(TKA).Methods A total of 90 patients who underwent elective unilateral knee replacement were enrolled.They were randomly divided into three groups(n=30):a ropivacaine 10 ml group(group A),a ropivacaine 20 ml group(group B)and a ropivacaine 30 ml group(group C).All patients underwent AC midpoint block guided by ultrasound after operation.Their VAS scores at rest and on movement at postoperative 6,12,24 and 48 h were recorded.Both groups were compared for 48 h cumulative dosage of sufentanil and dizocine,the quadriceps femoris muscle strength and active knee range of motion(ROM)before and after surgery,and the incidence of adverse reactions such as nausea and vomiting.Results Compared with group A,groups B and C showed remarkable decreases in VAS scores at rest and on movement at different time points after operation,cumulative consumption of sufentanil and dezocine at postoperative 48 h,and the incidence of nausea as well as vomiting,as well as increases in ROM at postoperative 24 h and 48 h(P<0.05).However,there was no statistical difference in the above parameters between groups B and C(P>0.05).Compared with group C,the muscle strength of the quadriceps femoris in groups A and B significantly increased at postoperative 24 h(P<0.05),but no statistical difference was found in the above parameter between groups A and B(P>0.05).Conclusions AC midpoint blocked with 0.375%ropivacaine at 20 ml can provide good postoperative analgesia for TKA,with little effect on quadriceps muscle strength,and promote the recovery of knee function after TKA.