两种多模式镇痛方案在全膝关节置换术中应用效果的比较

Comparison of two multimodal analgesia schemes in total knee arthroplasty

目的:探究两种多模式镇痛方案在全膝关节置换术(TKA)中的应用价值。方法:选取2020年6月至2022年2月于新乡市中心医院行单侧TKA的147例患者为研究对象,其中49例给予术前2 d塞来昔布胶囊口服+超声引导下腘动脉与膝关节后囊间隙(IPACK)阻滞及“鸡尾酒”疗法+术后自控静脉镇痛(PCIA)的多模式镇痛方案(A组),49例接受术前2 d塞来昔布胶囊口服+超声引导下股神经联合腘窝坐骨神经阻滞+术后PCIA的多模式镇痛方案(B组),余49例仅行术后PCIA(C组)。记录术前30 min、切皮、手术结束时心率、平均动脉压,记录患者苏醒、直腿抬高、下地及住院时间,记录患者术后自控镇痛泵按压次数。术后12、24、48 h后,于运动及静息状态下行视觉模拟疼痛评分(VAS),采用量角器评估患者关节活动度。结果:切皮、手术结束时,A、B组心率和平均动脉压低于C组(P<0.05)。A、B组自控镇痛泵按压次数、首次直腿抬高时间、下地时间、住院时间、苏醒时间均小于C组(P<0.05),A组首次直腿抬高时间、下地时间、住院时间小于B组(P<0.05)。术后48 h内,A、B组VAS均低于C组(P<0.05)。术后48 h内,A组各时间点关节活动度均大于B和C组(P<0.05)。结论:两种多模式镇痛方案在TKA术中均取得较好的镇痛效果,以IPACK阻滞联合“鸡尾酒”辅助为主的多模式镇痛方案的患者术后关节功能恢复更快。

Aim:To explore the application value of two different multimodal analgesia schemes in the total knee arthroplasty(TKA).Methods:A total of 147 patients accepted unilateral TKA from June 2020 to February 2022 were selected.Group A(n=49) received a multimodal analgesia program of celecoxib capsule orally 2 days before operation+ultrasound guided popliteal artery and posterior capsule space of knee joint(IPACK) block and "cocktail" therapy+postoperative patient-controlled intravenous analgesia(PCIA).Group B(n=49) received a multimodal analgesia program of celecoxib capsule orally 2 days before operation+ultrasound guided femoral nerve block combined with popliteal sciatic nerve block+PCIA after operation.Postoperative PCIA analgesia was performed in group C(n=49).The differences of vital signs,postoperative rehabilitation indicators,the number of times of analgesia pump pressing,visual analogue score(VAS) during exercise and rest,and joint activity were analyzed. Results: The heart rate and mean arterial pressure of Group A and B were lower than group C at skin incision and the end of operation(P < 0. 05). The first straight leg lifting time,landing time,hospitalization time,the recovery time and the press times of the PCIA of Group A and B were significantly lower than those of Group C(P < 0. 05). The VAS of Group A and B was significantly lower than Group C during 48 hours after operation(P < 0. 05). The joint range of motion in Group A during 48 hours after operation was larger than Group B and C(P <0. 05). Conclusion: The two multimodal analgesia schemes have better analgesic effect,and IPACK block combined with "cocktail" therapy as the main adjuvant analgesia schema result in faster joint function recovery.