超声引导下腘窝坐骨联合隐神经阻滞在膝关节置换术后镇痛的应用

Application of ultrasound-guided popliteal ischium combined with saphenous nerve block in analgesia after knee replacement

目的对比研究超声引导下腘窝坐骨联合隐神经阻滞在膝关节置换术后镇痛的临床应用价值。方法采用前瞻性随机对照研究,纳入新疆医科大学第六附属医院2020年10月至2021年10月收治的择期膝关节置换患者50例。按照数字随机法分为:B组(超声引导腘窝坐骨联合隐神经阻滞复合静脉镇痛药术后镇痛)和C组(静脉镇痛药术后镇痛)。所有患者均在腰硬联合麻醉下完成手术并在手术结束后连接一次性镇痛泵行静脉自控镇痛。B组手术前在患肢行超声引导腘窝坐骨联合隐神经阻滞;C组不做特殊处理。分别对两组患者一般资料(包括身高、体质量、年龄、手术时长)进行观察研究。两组患者术后2、4、6、8、10h的视觉模拟静息疼痛(RVAS)评分、术后4、6、8、10h的被动活动(PVAS)评分及6、8、10h的主动活动(IVAS)评分、术后不良反应、镇痛泵首次按压时间、按压次数、首次下床活动时间及镇痛满意度进行对比研究。结果两组患者一般资料比较无明显统计学差异。B组与C组比较:RVAS、PVAS、IVAS评分显著降低(P<0.05)。患者术后首次按压镇痛泵时间显著延长、按压次数显著降低、首次下床时间显著提前、不良反应发生率显著降低及术后镇痛满意度显著增高(P<0.05)。结论超声引导下腘窝坐骨联合隐神经阻滞联合静脉镇痛可明显降低膝关节置换术后早期的疼痛评分,能够减少镇痛泵的药物使用量,术后下床时间明显缩短,术后不良反应显著减少,能增加患者术后镇痛的满意度。超声引导下腘窝坐骨联合隐神经阻滞可安全有效的用于膝关节置换术后疼痛管理。

Objective To compare the clinical application value of ultrasound-guided popliteal sciatic nerve block combined with saphenous nerve block in analgesia after knee replacement.Methods A prospective randomized controlled study was conducted in 50 patients with knee joint replacement from October 2020 to October 2021 in the Sixth Affiliated Hospital of Xinjiang Medical University.According to the digital random method is divided into:Group B(ultrasound-guided popliteal ischium combined with saphenous nerve block combined with intravenous analgesics for postoperative analgesia)and group C(intravenous analgesics for postoperative analgesia).All patients were operated under combined spinal-epidural anesthesia and connected with disposable analgesia pump for intravenous patient-controlled analgesia after the operation.In group B,ultrasound-guided popliteal sciatic nerve block was performed on the affected limb pre-operation.Group C does not do special treatment.The general data(including height,weight,age and operation duration)of the two groups were observed and studied,With the visual simulated resting pain(RVAS)scores at 2h,4h,6h,8h,and 10h,passive activity(PVAS)scores at 4h,6h,8h,and 10h,and active activity(IVAS)scores at 6h,8h,and 10h after operation.Postoperative adverse reactions,the first pressing time,pressing times,the first time to get out of bed,and analgesic satisfaction of the two groups were compared.Results There was no significant difference in general data between the two groups.Compared with group C,the scores of RVAS,PVAS and IVAS in group B were significantly lower(P<0.05).After operation,the time of pressing the analgesic pump for the first time was significantly prolonged,the times of pressing were significantly reduced,the time of getting out of bed for the first time was significantly advanced,the incidence of adverse reactions was significantly reduced,and the postoperative analgesia satisfaction was significantly increased(P<0.05).Conclusion Ultrasound-guided popliteal sciatica combined with saphenous nerve block combined with intravenous analgesia can significantly reduce the pain score in the early stage after knee joint replacement,reduce the drug consumption of analgesic pump,shorten the time of getting out of bed after operation,significantly reduce the postoperative adverse reactions,and increase the satisfaction of patients with postoperative analgesia.Ultrasound-guided popliteal ischium combined with saphenous nerve block can be safely and effectively used for pain management after knee arthroplasty.