ACB联合IPACK阻滞与LFCNB用于全膝关节置换患者的效果研究

Effect of ACB Combined with IPACK Block and LFCNB in Patients with Total Knee Arthroplasty

目的:探讨收肌管阻滞(adductor canal block,ACB)联合腘动脉与膝关节后囊间隙(interspace between the popliteal artery and capsule of the knee,IPACK)阻滞与股外侧皮神经阻滞(lateral femoral cutaneous nerve block,LFCNB)对全膝关节置换术(total knee arthroplasty,TKA)的效果。方法:选择2018年7月-2020年8月在南通大学附属医院行单侧TKA的患者120例,按随机数字表法分为四组:A组(ACB联合IPACK阻滞与LFCNB)、B组(ACB联合IPACK阻滞)、C组(ACB联合LFCNB)及D组(ACB),每组30例。记录四组术后休息及活动时2、8、12、24、48 h视觉模拟评分法(VAS)评分、术后吗啡使用剂量及镇痛时间;记录膝关节屈曲角度、伸展角度、每日下床步行距离、出院时间;在出院和术后3个月随访时,记录四组膝关节评分法(knee society score,KSS)评分及西安大略和麦克马斯特大学(WOMAC)骨关节炎指数评分。记录住院期间四组不良反应的发生情况。结果:休息和活动状态下,术后2、8、12 h A、B、C组的VAS评分均低于D组,差异有统计学意义(P<0.05);术后2、8、12 h A组的VAS评分均低于B、C组,差异有统计学意义(P<0.05)。术后24、24~48 h A组吗啡药物消耗量及总消耗量均明显低于B、C、D组,差异有统计学意义(P<0.05)。A组吗啡镇痛时间均明显长于B、C、D组,差异有统计学意义(P<0.05)。四组KSS评分、WOMAC评分、住院时间和不良反应情况比较差异无统计学意义(P>0.05)。结论:ACB联合IPACK阻滞与LFCNB的多模式镇痛方法对TKA患者术后的镇痛效果更好,镇痛时间更长,且不会增加不良反应。

Objective:To investigate the postoperative effect of adductor canal block(ACB)combined with interspace between the popliteal artery and capsule of the knee(IPACK)block and lateral femoral cutaneous nerve block(LFCNB)in patients with total knee arthroplasty(TKA).Method:A total of 120 patients who underwent unilateral TKA in Affiliated Hospital of Nantong University from July 2018 to August 2020 were selected.According to the random number table method,they were divided into 4 groups:group A(ACB combined with IPACK block and LFCNB),group B(ACB combined with IPACK block),group C(ACB combined with LFCNB)and group D(ACB),with 30 cases in each group.The scores of visual analogue scale(VAS)at 2,8,12,24,48 hours after rest and activity,postoperative Morphine dosage and analgesia time of the four groups were recorded.The knee flexion angle,extension angle,daily walking distance from bed,and discharge time of the four groups were recorded.At discharge and 3 months postoperative follow-up,the knee society(KSS)score and Western Ontario and McMaster Universities(WOMAC)osteoarthritis index score were recorded.The occurrence of adverse reactions during hospitalization of the four groups were recorded.Result:At rest and active state,the VAS scores at 2,8 and 12 hours after operation in the groups A,B and C were lower than those in the group D,and the differences were statistically significant(P<0.05).The VAS scores in the group A at 2,8 and 12 hours after operation were lower than those in the group B and C,and the differences were statistically significant(P<0.05).The consumption of Morphine in the group A at 24 hours and from 24 to 48 hours after operation and the total consumption of Morphine were significantly lower than those of groups B,C and D,and the differences were statistically significant(P<0.05).The duration of Morphine analgesia in group A was significantly longer than that in groups B,C and D,and the differences were statistically significant(P<0.05).There were no significant differences in KSS score,WOMAC score,hospital stay and adverse reactions among the four groups(P>0.05).Conclusion:The multi-modal analgesia of ACB combined with IPACK block and LFCNB has better analgesic effect in patients with TKA,longer analgesia time,and does not increase the adverse reactions.