超声引导下单次隐神经阻滞联合“鸡尾酒”疗法治疗全膝关节置换术后疼痛的效果

Effect of Ultrasound-Guided Single-Injection Saphenous Nerve Block Combined with Cocktail Therapy on Pain after Total Knee Arthroplasty

目的探讨超声引导下单次隐神经阻滞联合“鸡尾酒”疗法治疗全膝关节置换术后疼痛的临床效果。方法择期行单侧全膝关节置换术的膝关节骨性关节炎患者90例,按随机数字表法分为研究组(n=45)与对照组(n=45)。2组患者术中安放膝关节假体前均行关节周围“鸡尾酒”注射。术后即刻,研究组患者在超声引导下行隐神经阻滞麻醉,对照组患者于隐神经阻滞区注射等量生理盐水。2组患者术后行主动功能锻炼。记录并比较2组患者术后膝关节静息及活动时疼痛评分(VAS评分)、首次行走距术后时间、膝关节功能评分(KSS评分)、术后追加镇痛药物患者数及镇痛药物剂量。记录并描述患者术后并发症发生情况。结果术后12、24、48 h研究组患者膝关节静息及活动时VAS评分显著低于对照组(P<0.05);术后72 h,2组患者膝关节静息及活动时VAS评分差异无统计学意义(P>0.05)。术后12、24 h活动时,术后48 h静息时及活动时,研究组患者膝关节无痛或轻度疼痛所占比例高于对照组(P<0.05);其余时间节点2组患者膝关节不同疼痛程度所占比例差异无统计学意义(P>0.05)。研究组患者首次行走距术后时间显著短于对照组(P<0.05)。研究组患者术后3个月膝关节KSS评分及KSS评分较术前增加值均显著高于对照组(P<0.05)。术后72 h内,研究组追加镇痛药物患者比例显著低于对照组(P<0.05),且追加镇痛药物剂量更少(P<0.05)。术后未见隐神经阻滞相关并发症。结论超声引导下单次隐神经阻滞联合“鸡尾酒”疗法治疗全膝关节置换术后疼痛的效果优于单纯“鸡尾酒”疗法,是一种安全、有效的多模式镇痛方法。

Objective To investigate the clinical effect of ultrasound-guided single-injection saphenous nerve block combined with cocktail therapy on pain after total knee arthroplasty(TKA).Methods A total of 90 patients who received unilateral TKA were randomly divided into two groups,with 45 patients in each group.Both groups underwent peri-articular cocktail injection before implantation of the knee prosthesis.Immediately after surgery,the study group was given ultrasound-guided saphenous nerve block,but the control group was injected with the same amount of normal saline in the block area.All the patients underwent active functional exercise after surgery.Visual Analogue Scale(VAS)pain scores at rest and during movement,time to the first postoperative walking,Knee Society Score(KSS),number of patients receiving analgesic drugs after surgery,dosage of analgesic drugs,and postoperative complications were compared between the two groups.Results The VAS scores at rest and during movement in the study group were lower than those in the control group at 12,24 and 48 hours after surgery(P<0.05).There were no significant differences in the VAS scores between the two groups at 72 hours after surgery(P>0.05).The proportion of patients with painless or mild pain in the study group was higher than that in the control group at rest at 12 and 24 hours after surgery,as well as at rest and during movement at 48 hours after surgery.There was no significant difference in the proportion of different degrees of knee pain between the two groups at other timepoints(P>0.05).The time to the first postoperative walking in the study group was shorter than that in the control group(P<0.05).At 3 months after operation,the KSS score in the study group was higher than that in the control group,and the increase in KSS score in the study group was greater than that in the control group(P<0.05).Within 72 hours after operation,the proportion of patients receiving additional analgesic drugs and the dosage of additional analgesic drugs in the study group were lower than those in the control group(P<0.05).No postoperative complications associated with saphenous nerve block were found in both groups.Conclusion As a safe,effective and multimodal analgesic method,the combination of ultrasound-guided single-injection saphenous nerve block and cocktail therapy is superior to cocktail therapy alone for pain after TKA.