超声引导下隐神经阻滞在老年患者全膝关节置换术后多模式镇痛中的效果

Effect of saphenous nerve block guided by ultrasound on multimode analgesia after total knee arthroplasty in elderly patients

目的 观察超声引导下隐神经阻滞(saphenous nerve block,SNB)在老年患者全膝关节置换术(total knee arthroplasty,TKA)后多模式镇痛中的效果。方法 选取2019年12月至2021年12月于南京医科大学附属无锡人民医院行单侧TKA的老年膝关节骨关节炎患者50例,根据随机数字表法将其分为股神经阻滞(femoral nerveblock,FNB)组和SNB组,每组各25例。FNB组患者于术后行超声引导下FNB,SNB组患者于术后行超声引导下SNB。比较两组患者阻滞后4h、8h、12h、24h、36h、48h的视觉模拟评分法(visual analogue scale,VAS)评分、膝关节最大屈曲度和股四头肌肌力。同时记录两组患者的术后吗啡使用率和阿片类药物不良反应发生率。结果 两组患者阻滞后各时间点的VAS评分比较差异均无统计学意义(P>0.05)。阻滞后24h、36h、48h,SNB组患者的膝关节最大屈曲度显著大于FNB组(P<0.05);阻滞后8h、12h、24h、36h、48h,SNB组患者的股四头肌肌力均显著优于FBN组(P<0.05)。两组患者的吗啡使用率、阿片类药物不良反应发生率比较差异均无统计学意义(P>0.05)。结论 在老年患者TKA术后多模式镇痛中,与FNB相比,SNB对膝关节屈曲度和股四头肌肌力的影响较小,有利于患者早期活动和促进关节功能恢复。

Objective To observe the effect of saphenous nerve block(SNB) guided by ultrasound in multimode analgesia after total knee arthroplasty(TKA) in elderly patients. Methods Fifty elderly patients with knee osteoarthritis who underwent unilateral TKA in Wuxi People’s Hospital Affiliated to Nanjing Medical University from December 2019 to December 2021 were randomly divided into femoral nerve block(FNB) group and SNB group with 25 cases in each group. Patients in FNB group underwent ultrasound-guided FNB after operation, and patients in SNB group underwent ultrasound-guided SNB after operation. The visual analogue scale(VAS), the maximum flexion degree of knee joint and muscle strength of quadriceps femoris were observed and recorded at 4h,8h, 12h, 24h, 36h and 48h after block. Meanwhile, the use of morphine and the incidence of opioid adverse reactions were recorded after operation. Results There was no significant difference in VAS scores between the two groups at each time point after block(P>0.05). The maximum flexion degree of knee joint in SNB group were significantly higher than those in FNB group at 24h, 36h and 48h after block(P<0.05). The muscle strength of quadriceps femoris in SNB group were significantly better than those in FBN group at 8h, 12h, 24h, 36h and 48h after block(P<0.05). There were no significant differences in the use of morphine and the incidence of opioid adverse reactions between the two groups(P>0.05). Conclusion Compared with FNB in multimodal analgesia after TKA,SNB has less effect on knee flexion and quadriceps femoris muscle strength, which is beneficial to early movement and joint function recovery of patients.