超声引导下2种入路收肌管神经阻滞对全膝关节置换术后镇痛和运动功能的影响

Effect of two approaches of ultrasound-guided adductor canal nerve block on analgesia and motor function after total knee arthroplasty

目的比较超声引导下近端入路收肌管神经阻滞(PACB)和远端入路收肌管神经阻滞(DACB)对全膝关节置换术(TKA)后镇痛和运动功能的影响。方法选择择期行TKA患者64例,男29例,女35例,年龄50~75岁,BMI<28 kg/m 2,美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级,采用随机数字表法分为2组:PACB组和DACB组,每组32例。PACB组行超声引导下DACB;DACB组行超声引导PACB。2组均给予0.375%罗哌卡因20 mL。记录收肌管神经阻滞(ACB)时间、手术时间及一般资料。记录术后4、6、8、12、24、48 h的静息和运动视觉模拟评分(VAS);术前及术后24、48 h的股四头股肌力和膝关节活动度(ROM);术后24 h内舒芬太尼的总消耗量、补救镇痛次数和不良反应,包括神经损伤、头晕、跌倒的发生情况。结果2组ACB时间、手术时间及一般资料差异无统计学意义(P>0.05)。DACB组术后4、8、12 h静息和运动VAS明显低于PACB组(P<0.05),术后24、48 h 2组静息和运动VAS比较差异无统计学意义(P>0.05)。与术前比较,PACB组和DACB组术后24 h股四头肌肌力、ROM明显下降(P<0.05),PACB组术后48 h股四头肌肌力明显下降(P<0.05)。与PACB组比较,DACB组术后24、48 h肌四头肌肌力、ROM明显增高(P<0.05)。DACB组24 h芬太尼总消耗量及补救镇痛次数低于PACB组(P<0.05)。结论超声引导下ACB为TKA后提供良好的镇痛效果,DACB较PACB效果更佳,可减少术后24 h阿片药物用量,提高术后ROM,有助于患者快速康复。

Objective To compare the effects between ultrasound-guided proximal approach adductor canal nerve block(PACB)and distal approach adductor canal nerve block(DACB)on analgesia and motor function after total knee arthroplasty(TKA).Methods Sixty-four patients with elective TKA were selected,which contained 29 males and 35 females,aged from 50 to 75 years old,BMI<28 kg/m 2,ASA gradeⅠorⅡ,they were divided into the two groups through random number table method:the PACB group and the DACB group,with 32 cases in each group.The PACB group underwent the ultrasound-guided PACB.The DACB group underwent the ultrasound-guided DACB.Both groups were given 0.375%ropivacaine 20 mL.The time of adductor canal block(ACB),operation time and general data were recorded.The VAS scores of rest and exercise at the time of 4,68,12,24 and 48 h after operation were recorded.The quadriceps muscle strength and knee range of motion(ROM)before surgery and at the time of 24 and 48 h after operation were recorded;total consumption amounts of sufentanil,time of remedial analgesia,and adverse reactions including nerve injury,dizziness and fall within 24 h after operation were recorded.Results There were no statistically significant differences in the time of ACB,operation time and general data between the two groups.The resting and exercise VAS at the time of 4,8 and 12 h after operation in the DACB group were significantly lower than those in the PACB group(P<0.05),and the resting and exercise VAS scores at the time of 24,48 h after operation had no statistical difference between the two groups(P>0.05).Compared with before operation,the quadriceps muscle strength and ROM at the time of 24 h after operation in the PACB group and DACB group was significantly decreased(P<0.05),the quadriceps muscle strength at the time of 48 h after operation in the PACB group was significantly decreased(P<0.05).Compared with the PACB group,the quadriceps muscle strength and ROM at the time of 24,48 h after operation in the DACB group was significantly increased(P<0.05).The fentanyl total consumption amount and times of remedial analgesia at 24 h after operation in the DACB group were lower than those in the PACB group.Conclusion The ultrasound-guided ACB offers good analgesic effect after TKA,DACB has better effect than PACB,which could decrease opiates amounts at 24 h after operation,and increase the postoperative knee ROM.It is conducive to rapid rehabilitation of the patients.