收肌管联合胫神经阻滞对全膝关节置换术后镇痛的影响

目的评估全膝关节置换术(TKA)患者术后应用收肌管阻滞(ACB)联合胫神经阻滞(TNB)的镇痛效果。方法选取2022年10月至2023年1月在本院拟全身麻醉下首次行单侧TKA的择期手术患者60例,使用随机数字表法将纳入的患者分为ACB组(A组)和ACB联合TNB组(AT组),每组各30例。在TKA术后,两组患者均采用0.375%罗哌卡因15 mL在超声引导下行ACB,AT组在超声引导下使用0.375%罗哌卡因15 mL追加行TNB。使用视觉模拟评分法(VAS)评估术后疼痛,在患者离开麻醉恢复室时连接静脉自控镇痛泵(PCIA),设置追加剂量为吗啡0.05 mg/kg,锁定时间10 min,无负荷量和背景输注,患者VAS评分在>3分时可自行按压自控镇痛按键给予追加剂量。记录阻滞成功例数,两组患者术后24 h和48 h的吗啡消耗量、患者自主最大膝关节活动度,记录术后神经阻滞相关并发症、恶心呕吐、瘙痒等不良反应的发生情况。结果两组阻滞成功率、术后48 h时患者自主最大膝关节活动度和术后恶心呕吐及皮肤瘙痒的发生率比较差异无统计学意义(P>0.05)。而术后24 h与48 h吗啡消耗量A组相较于AT组减少(P<0.05);术后24 h时患者最大膝关节自主活动度A组明显小于AT组。A组与AT组均未见神经阻滞相关的并发症。结论在超声引导下行ACB联合TNB用于单侧TKA,可为患者提供更完善的镇痛效果和更舒适的早期康复训练条件,有一定的临床应用价值。

Objective To evaluate the analgesic efficacy of adductor canal block(ACB)plus tibial nerve block(TNB)post-total knee arthroplasty(TKA).Methods Sixty patients undergoing unilateral TKA were randomly allocated into two groups:the ACB alone group(Group A)and the ACB with TNB group(Group AT),with 30 participants in each group.Both groups received 15 mL of 0.375%ropivacaine for ACB under ultrasound,while Group AT had an additional TNB.Pain was evaluated using the Visual Analog Scale(VAS),and patient-controlled intravenous analgesia(PCIA)was administered postoperatively.Morphine consumption,knee mobility,and adverse effects were recorded at 24 h and 48 h.Results There was no significant difference in block success rate,knee mobility at 48 h,or incidence of nausea and itching between groups.Group A had reduced morphine consumption and lower knee mobility at 24 h compared to Group AT.No block-related complications were observed.Conclusion Ultrasound-guided ACB combined with TNB for unilateral TKA offers superior pain control and favorable conditions for early rehabilitation,demonstrating clinical value.