腘丛神经联合收肌管阻滞对全膝关节置换术后镇痛的影响分析

Effect of popliteal plexus nerve combined with adductor muscle block on postoperative analgesia after TKA surgery

目的 观察腘丛神经(PPB)联合收肌管阻滞(ACB)对全膝关节置换术(TKA)术后镇痛的影响。方法 选择平顶山市第一人民医院2022年1月至2023年6月期间收治的行TKA手术治疗的125例患者为研究对象,经数字表法将其分为常规组(62例)和联合组(63例),常规组采用ACB进行术后镇痛;联合组采用PPB联合ACB进行术后镇痛,比较2组的术后疼痛情况、术后自控镇痛情况、术后恢复情况及麻醉安全性。结果 在不同镇痛模式下,联合组术后24 h、术后72 h静息时的视觉模拟疼痛量表(VAS)评分分别为(4.23±1.46)分、(3.15±0.47)分,均低于常规组[(5.11±2.04)分、(4.36±1.27)分];术后24 h、术后72 h活动时的VAS评分分别为(4.91±1.47)分、(3.77±0.28)分,均低于常规组[(5.33±2.04)分、(4.69±1.31)分];联合组术后自控镇痛泵(PCIA)有效按压次数、总按压次数、镇痛补救例数分别为(7.2±1.4)次、(4.2±1.2)次、32%(20/63),均低于常规组[(9.4±2.3)次、(5.4±1.4)次、47%(29/62)];联合组术后首次下床时间、恢复自主活动时间、住院时间分别为(20±5)h、(23±5)h、(14±3)d,均低于常规组[(23±5)h、(26±5)h、(17±4)d];联合组术后24 h、72 h的膝关节活动度分别为(68±10)°、(76±10)°,均高于常规组[(62±10)°、(69±10)°];术后24 h、术后72 h的股四头肌肌力分别为(3.77±0.25)、(4.52±1.36)级,均高于常规组[(3.12±0.76)、(4.13±0.52)级],差异具有统计学意义(P<0.05)。联合组术后麻醉相关不良反应发生率10%(6/63)与常规组8%(5/62)比较,差异无统计学意义(P>0.05)。结论 在TKA术后镇痛中联合应用PPB及ACB可有效缓解患者术后疼痛,并减少PCIA按压次数,对加快患者术后康复进程并促进下肢功能恢复均有积极意义,二者联合应用未明显增加麻醉相关不良反应发生风险,安全性较高。

Objective To observe the effect of popliteal plexus block(PPB)combined with abductor muscle block(ACB)on postoperative analgesia after total knee arthroplasty(TKA)surgery.Methods Randomly selecte 125 patients who underwent TKA surgery at our hospital from January 2022 to June 2023 as the study subjects.They were divided into a conventional group(62 cases)and a combination group(63 cases)using a digital table method.The conventional group received postoperative analgesia using ACB,while the combination group received postoperative analgesia using PPB combined with ACB.The postoperative pain,postoperative self-control analgesia,postoperative recovery,and anesthesia safety of the two groups were compared.Results Under different analgesic modes,the visual analogue scale(VAS)scores of the combined group at rest 24 hours and 72 hours after surgery were(4.23±1.46)and(3.15±0.47)points,respectively,lower than those of the conventional group[(5.11±2.04)and(4.36±1.27)points].The VAS scores at 24 hours and 72 hours after surgery were(4.91±1.47)points and(3.77±0.28)points,respectively,lower than those in the conventional group[(5.33±2.04)points and(4.69±1.31)points].The effective number of postoperative patient-controlled intravenous analgesia(PCIA)compressions,total number of compressions,and number of pain relief cases in the combined group were(7.2±1.4),(4.2±1.2),and 32%(20/63),respectively,which were lower than those in the conventional group[(9.4±2.3),(5.4±1.4),and 47%(29/62)].The first postoperative time to get out of bed,time to resume autonomous activity,and hospital stay in the combined group were(20±5)hours,(23±5)hours,and(14±3)days,respectively,which were lower than those in the conventional group[(23±5)hours,(27±5)hours,and(17±4)days].The range of motion of the knee joint in the combined group was (68±10)° and (76±10)° 24 and 72 hours after surgery, respectively, which were higher than those in the conventional group [(62±10)° and (69±10)°]. The quadriceps muscle strength at 24 hours and 72 hours after surgery was (3.77±0.25) and (4.52±1.36), respectively, which were higher than those in the conventional group [(3.12±0.76) and (4.13±0.52)] (P<0.05). The incidence of postoperative anesthesia-related side effects in the combined group was 10% (6/63), that in the conventional group was 8% (5/62)which had no significance (P>0.05). Conclusion The combination of PPB and ACB in TKA postoperative analgesia can effectively alleviate postoperative pain in patients, reduce the number of PCIA compressions, accelerate the postoperative recovery process of patients, and promote lower limb function recovery. The combination of the two does not significantly increase the risk of anesthesia-related side effects and has high safety.