超声引导下收肌管阻滞联合股外侧皮神经阻滞用于全膝关节置换术患者术后镇痛的随机对照研究

Randomized Controlled Study of Ultrasound-guided Adductor Block Combined with Lateral Femoral Cutaneous Nerve Block for Postoperative Analgesia in Patients with Total Knee Replacement

目的评价超声引导下收肌管阻滞联合股外侧皮神经阻滞用于全膝关节置换术患者术后镇痛的效果。方法选取2020年6月—2021年6月苏州平江医院行单侧全膝关节置换术的患者100例,随机分为收肌管阻滞联合股外侧皮神经阻滞组(adductor canal block combined with lateral femoral cutaneous nerve block group,ACB+LFCNB组)和局部浸润麻醉组(local infiltration anesthesia group,LIA组),各49例。ACB+LFCNB组患者实施超声引导下收肌管阻滞联合股外侧皮神经阻滞,LIA组患者行局部浸润麻醉。比较两组静止和活动状态下NRS评分、术后Bromage评分、PCIA按压次数、首次补救镇痛时间、首次下床时间、补救镇痛及PONV发生率。结果静止状态下,ACB+LFCNB组术后8、12 h的NRS评分均显著低于LIA组,差异有统计学意义(t=2.401、2.441,P<0.05);活动状态下,ACB+LFCNB组术后12 h的NRS评分显著低于LIA组,差异有统计学意义(t=2.884,P<0.05)。ACB+LFCNB组术后2、8、12 h的Bromage评分显著均高于LIA组,差异有统计学意义(t=7.766、7.653、7.799,P<0.05)。ACB+LFCNB组PCIA按压次数、补救镇痛例数均显著低于LIA组,差异有统计学意义(t=2.294,χ^(2)=8.827,P<0.05)。ACB+LFCNB组和LIA组首次补救镇痛时间分别为(10±2)、(8±2)h,差异有统计学意义(t=4.950,P<0.05)。结论超声引导下收肌管阻滞联合股外侧皮神经阻滞用于全膝关节置换术患者术后镇痛效果明显,但可能会影响下肢活动功能。

Objective To evaluate the effect of ultrasound-guided adductor canal block combined with lateral femoral cutaneous nerve block on postoperative analgesia in patients with total knee replacement.Methods 100 patients who were performed to undergo unilateral total knee arthroplasty in Suzhou Pingjiang Hospital from June 2020 to June 2021 were randomly divided into two groups,the adductor canal block combined with lateral femoral cutaneous nerve block group(ACB+LFCNB group)and the local infiltration anesthesia group(LIA group),with 49 patients in each group.Patients in ACB+LFCNB group were treated with ultrasound-guided adductor tube block combined with lateral femoral cutaneous nerve block,while patients in LIA group were treated with local infiltration anesthesia.Compare the NRS scores of the two groups in static and active state Bromage score after operation,PCIA press times,the time of first relief analgesia,the time of first getting out of bed,the rate of relief analgesia and PONV were compared between the two groups.Results At rest,the NRS scores of patients in the ACB+LFCNB group were significantly lower than those in the LIA group at 8 h and 12 h after operation,the difference was statistically significant(t=2.401,2.441,P<0.05);in active state,the NRS score of patients in ACB+LFCNB group was significantly lower than that in LIA group at 12 h after operation,the difference was statistically significant(t=2.884,P<0.05).The Bromage scores of patients in the ACB+LFCNB group were significantly higher than those in the LIA group at 2 h,8 h and 12 h after operation,the difference was statistically significant(t=7.766,7.653,7.799,P<0.05).The number of PCIA compressions and cases of relief analgesia in the ACB+LFCNB group were significantly lower than those in the LIA group,the difference was statistically significant(t=2.294,χ^(2)=8.827,P<0.05).The first rescue analgesia time in ACB+LFCNB group and LIA group was(10±2)h and(8±2)h respectively,the difference was statistically significant(t=4.950,P<0.05).Conclusion Ultrasound-guided adductor canal block combined with lateral femoral cutaneous nerve block has obvious analgesic effect in patients undergoing total knee replacement,but it may affect lower limb function.