股神经阻滞辅助全身麻醉对行全膝关节置换术患者术后疼痛和炎症反应的影响

Effects of femoral nerve block-assisted general anesthesia on postoperative pain and inflammatory response in patients undergoing total knee arthroplasty

目的:探讨股神经阻滞联合全身麻醉对全膝关节置换术(TKA)患者术后镇痛和炎症反应的影响。方法:选取2022年5月至2023年5月在该院行TKA治疗的120例患者进行前瞻性研究。依据随机数字表法将其分为对照组与研究组各60例。两组均采用静吸复合全身麻醉。研究组在麻醉诱导前实施超声引导下股神经阻滞,注入20 mL 0.375%盐酸罗哌卡因,对照组注射等量生理盐水,术后均予以舒芬太尼静脉镇痛48 h。比较两组术中和术后舒芬太尼用量、术后4~48 h视觉模拟评分法(VAS)评分、手术前后血清炎性因子[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]水平及不良反应发生率。结果:研究组术中、术后舒芬太尼用量均低于对照组,差异有统计学意义(P<0.05);研究组术后4、12、24 h的VAS评分均低于对照组,差异有统计学意义(P<0.05);术后24 h,两组血清IL-6、TNF-α水平均高于术前,但研究组低于对照组,差异有统计学意义(P<0.05);研究组不良反应发生率为8.33%(5/60),低于对照组的28.33%(17/60),差异有统计学意义(P<0.05)。结论:股神经阻滞辅助全身麻醉用于TKA患者可减少围术期阿片类药物用量,降低不良反应发生率和术后炎性因子水平,减轻术后疼痛程度,效果优于单纯全身麻醉。

Objective:To investigate effects of femoral nerve block-assisted general anesthesia on postoperative pain and inflammatory response in patients undergoing total knee arthroplasty(TKA).Methods:A prospective study was conducted on 120 patients who underwent TKA in this hospital from May 2022 to May 2023.According to the random number table method,these patients were divided into control group and study group,60 cases in each group.Both groups were treated with combined intravenous and inhalation anesthesia.The study group was given ultrasound-guided femoral nerve block before anesthesia induction(injection of 20 mL of 0.375%Ropivacaine hydrochloride),while the control group was injected with the same amount of normal saline.Sufentanil intravenous analgesia was given for 48 h after the surgery for the two groups.The intraoperative and postoperative Sufentanil dosage,the visual analogue scale(VAS)score 4-48 h after the surgery,the serum inflammatory factors[interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)]levels before and after the surgery,and the incidence of adverse reactions were compared between the two groups.Results:The intraoperative and the postoperative Sufentanil dosage levels in the study group were significantly less than those in the control group,and the differences were statistically significant(P<0.05).The VAS scores of the study group 4,12 and 24 h after the surgery were significantly lower than those of the control group,and the differences were statistically significant(P<0.05).24 h after the surgery,the levels of serum IL-6 and TNF-αin the two groups were higher than those before the surgery,but those in the study group were lower than those in the control group,and the differences were statistically significant(P<0.05).Further,the incidence of adverse reactions in the study group was 8.33%(5/60),which was lower than 28.33%(17/60)in the control group,and the difference was statistically significant(P<0.05).Conclusions:Femoral nerve block-assisted general anesthesia for the TKA patients can reduce the dosage of opioids during perioperative period,reduce the incidence of adverse reactions and the levels of postoperative inflammatory factors,and reduce the degree of postoperative pain.Moreover,it is superior to simple general anesthesia.