收肌管入路神经阻滞用于全膝关节置换术后镇痛的效果

Analgesic Effect of Saphenous Nerve Block Via Adductor Approach for Total Knee Arthroplasty

目的探讨全膝关节置换(TKA)术后应用收肌管入路神经阻滞镇痛的效果。方法选择2020年6月至2022年12月在佛山健翔骨伤医院接受TKA治疗患者82例,按照随机数字表法分为S组(41例)和G组(41例)。S组应用收肌管入路神经阻滞进行术后镇痛,G组应用股三角入路神经阻滞进行术后镇痛。比较两组术后不同时间节点疼痛视觉模拟评分(VAS)、股四头肌肌力分级差异,比较两组72h内镇痛补救率、满意度评分和不良反应发生率差异。术后对两组随访6个月,比较患者术后2周、4周、6个月时膝关节学会评分(KSS)。结果两组术后不同时间节点疼痛VAS、股四头肌肌力分级、KSS评分行重复测量方差分析,满足球形检验假设(P<0.05)。主效应方差分析显示,两组术后不同时间节点疼痛VAS评分、股四头肌肌力分级和术后2周、4周KSS评分差异有统计学意义(P<0.05)。两组术后6个月KSS评分差异无统计学意义(P=0.760)。S组72h内镇痛补救率低于G组(P<0.05),满意度评分高于G组(P<0.05)。结论与股三角入路比较,收肌管入路神经阻滞用于TKA术后镇痛效果更优,可作为TKA术后镇痛优选方案。

Objective To investigate the analgesic effect of saphenous nerve block via adductor tunnel approach on total knee arthroplasty(TKA).Methods 82 patients with TKA in our hospital from June 2020 to December 2022 were randomly divided into two groups,with 41 cases in each group.Saphenous nerve block via adductor canal was used in group S,and saphenous nerve block via femoral triangle approach was used in group G for postoperative analgesia.Visual analogue scale(VAS)score and quadriceps muscle strength were compared between the two groups at different time points after operation.The pain relief rate,satisfaction score and incidence of adverse reactions were compared between the two groups within 72 hours.The knee joint Society score(KSS)was compared in 2 weeks,4 weeks and 6 months after operation.Results The VAS scores of resting state and exercise state pain of group S were lower than those of group G at 6 h,12 h,24 h and 48 h after operation(P<0.01),and the recovery rate of analgesia was lower than that of group G(P<0.05);The muscle strength grade of quadriceps femoris of group S was higher than that of group G(P<0.01),and the satisfaction score at 72 h was higher than that of group G(P<0.01).The KSS score of group S was higher than that of group G at 2 and 4 weeks after operation(P<0.01),but there was no significant difference in KSS score between the two groups at 6 months after operation(P>0.05).Conclusion The adductor tunnel approach has better analgesic effect and less influence on lower limb muscle strength compared with the femoral triangle approach,which is conducive to early improvement of knee joint function,