收肌管阻滞联合IPACK在全膝关节置换术患者中的应用

Application of adductor block combined with IPACK block in patients undergoing total knee arthroplasty

目的 探讨收肌管阻滞(ACB)联合腘动脉-膝关节囊后间隙阻滞(IPACK)在全膝关节置换术患者中的应用效果。方法 选择2021年5月至2022年5月安康市中心医院收治的200例拟行全膝关节置换术的患者作为研究对象,按照随机数表法分为观察组和对照组各100例。对照组行ACB麻醉,观察组行ACB联合IPACK麻醉;两组患者均行术后静脉镇痛。比较两组患者围术期情况,术后6 h、12 h、24 h、48 h的静息时、活动时视觉模拟评分法(VAS)评分、肌力及术前、术后7 d时的膝关节活动度、最大屈曲角度,同时比较两组患者的不良反应发生情况。结果 观察组患者的术后首次补救镇痛时间、下床时间分别为(9.18±1.47) h、(3.53±0.68) d,均优于对照组的(6.23±1.26) h、(4.87±0.55) d,镇痛泵按压次数、舒芬太尼用量分别为(0.96±0.14)次、(65.82±13.47)μg,明显少于对照组的(2.13±0.56)次、(87.35±15.91)μg,差异均有统计学意义(P<0.05);观察组患者术后6 h、12 h静息时VAS评分分别为(1.82±0.37)分、(1.91±0.24)分,明显低于对照组的(3.06±0.28)分、(3.17±0.32)分,术后6 h、12 h活动时VAS评分分别为(1.96±0.30)分、(2.05±0.28)分,明显低于对照组的(3.26±0.21)分、(3.41±0.39)分,差异均具有统计学意义(P<0.05),但两组患者术后24 h、48 h静息时、活动时的VAS评分比较差异均无统计学意义(P>0.05);两组患者术后6 h、12 h、24 h、48 h的肌力比较差异均无统计学意义(P>0.05);术后7 d,观察组患者的膝关节活动度、最大屈曲角度分别为(91.02±9.69)°、(97.32±11.29)°,明显大于对照组的(86.33±7.17)°、(90.03±10.65)°,差异均有统计学意义(P<0.05);观察组和对照组患者不良反应发生率分别为5.00%和8.00%,差异无统计学意义(P>0.05)。结论 ACB联合IPACK在全膝关节置换术患者中的应用效果较好,安全性高。

Objective To investigate the effect of adductor block(ACB)combined with interspace between the popliteal artery and capsule of the knee(IPACK)block in patients undergoing total knee arthroplasty.Methods A total of 200 patients receiving total knee arthroplasty admitted to Ankang Central Hospital from May 2021 to May 2022 were selected as research objects,and they were divided into an observation group and a control group by the random number table method,with 100 patients in each group.The control group received ACB for anesthesia,and the observation group received ACB combined with IPACK block.The two groups of patients all underwent postoperative intravenous analgesia.The perioperative conditions between the two groups were compared,the rest and activity Visual Analogue Scale(VAS),and muscle strength at 6 h,12 h,24 h,and 48 h after surgery,the range of motion,and maximum flexion angle of knee joint at before and 7 days after surgery were compared.The incidence of adverse reactions was compared.Results The first postoperative analgesic time and the time to get out of bed in the observation group were(9.18±1.47)h and(3.53±0.68)d,which were significantly better than(6.23±1.26)h and(4.87±0.55)d in the control group;the number of analgesic pump compressions and sufentanil dosage were(0.96±0.14)times and(65.82±13.47)μg,which were significantly lower than(2.13±0.56)times and(87.35±15.91)μg in the control group;the differences were statistically significant(P<0.05).The rest VAS scores at 6 h,12 h after surgery in the observation group were(1.82±0.37)points and(1.91±0.24)points,which were significantly lower than(3.06±0.28)points and(3.17±0.32)points in the control group;the activity VAS scores at 6 h,12 h after surgery were(1.96±0.30)points and(2.05±0.28)points,which were significantly lower than(3.26±0.21)points and(3.41±0.39)points in the control group;the differences were statistically significant(P<0.05).There was no statistically significant difference in VAS scores between the two groups at rest and activity at 24 and 48 hours after surgery(P>0.05).There was no significant difference in muscle strength between the two groups at 6 h,12 h,24 h,and 48 h after surgery(P>0.05).At 7 d after surgery,the range of motion and maximum flexion angle in the observation group were(91.02±9.69)°and(97.32±11.29)°,respectively,which were significantly higher than(86.33±7.17)°and(90.03±10.65)°of the control group(P<0.05).The incidence of adverse reactions in observation group and control group patients was 5.00%and 8.00%,and the difference was not statistically significant(P>0.05).Conclusion The application effect of ACB combined with IPACK in total knee replacement patients is significant,with good safety.